Association Between Peripheral Neuropathy-Related Symptoms and Fall Risk in Middle-Aged and Older Adults With or Without Diabetes

Background: Peripheral neuropathy-related symptoms may contribute to impaired mobility and increased fall risk in middle-aged and older adults. Objectives: To investigate the association between peripheral neuropathy-related symptoms and fall-risk classification assessed using the FallSkip® wearable system in middle-aged and older adults with and without diabetes, and to identify specific symptoms associated with increased fall risk. Methods: This cross-sectional study included 85 participants aged over 50 years (65.9% women), of whom 39 (45.9%) had diabetes. Peripheral neuropathy-related symptoms were assessed using the Michigan Neuropathy Screening Instrument (MNSI), while fall risk was evaluated using the FallSkip® wearable system. Fall-risk categories were dichotomized into low and moderate/high risk. Associations were examined using bivariate analyses and multivariable logistic regression, including Firth’s penalized likelihood method. The potential modifying effect of diabetes status was also investigated. Results: Overall, 58.8% of participants were classified as having moderate/high fall risk. This proportion was higher among individuals with diabetes than among those without diabetes (69.2% vs. 50.0%), although the difference was not statistically significant (p = 0.073). Prickling sensations in the legs or feet (MNSI item 5) were more frequently reported by participants with diabetes (46.2% vs. 21.7%; p = 0.017). In multivariable Firth logistic regression, prickling sensations were independently associated with higher odds of moderate/high fall-risk classification (adjusted OR = 3.31; 95% CI: 1.04–12.24; p = 0.042), as was female sex (adjusted OR = 3.24; 95% CI: 1.18–9.48; p = 0.023). Diabetes status was not significantly associated with fall-risk classification after adjustment (p = 0.280). The interaction between diabetes status and the MNSI Part A score was not statistically significant (adjusted OR = 1.66; 95% CI: 0.78–3.52; p = 0.189). In stratified analyses, higher MNSI Part A scores were associated with increased odds of moderate/high fall-risk classification among participants with diabetes (adjusted OR = 1.80; 95% CI: 1.03–3.13; p = 0.038), but not among those without diabetes (adjusted OR = 1.18; 95% CI: 0.65–2.13; p = 0.589). Conclusions: Prickling sensations in the lower extremities and female sex were independently associated with increased odds of moderate/high FallSkip®-defined fall-risk classification. These findings suggest that specific neuropathy-related symptoms may be clinically relevant when assessing fall risk in middle-aged and older adults. However, the small sample size and cross-sectional design warrant cautious interpretation. Larger prospective studies are needed to confirm these associations and determine whether they differ according to diabetes status.