Balance impairment in diabetic peripheral neuropathy: Where do we stand?

Diabetic peripheral neuropathy (DPN) is one of the most frequent complications of diabetes mellitus (DM). The aim of this brief narrative review was to discuss the relationship between DPN and balance impairment. DPN may alter movement perception as a result of diminished proprioceptive and cutaneous input from skin, muscles and joints, leading to balance impairment. In everyday practice, diagnosis of impaired balance relies on a combination of clinical history, physical examination and functional tests, such as the Timed Up and Go test or the Berg Balance Scale, as well as instrumental assessments where available. Therapeutic principles include optimised glycaemic control and management of vascular risk factors for prevention and management of DPN. While these measures do not directly improve balance, they may contribute to better postural stability by preserving peripheral nerve function, reducing the progression of neuropathic deficits, and maintaining muscle strength. In addition, general exercises for balance improvement, physiotherapy, and focused and specialised strengthening, stretching and functional training programs may improve static and dynamic balance. Finally, electric stimulation has demonstrated positive results in improving postural stability in DPN.