Cognitive function and cardiorespiratory fitness affect gait speed in type-2 diabetic patients without neuropathy

AIM: To identify physical, cognitive, and metabolic factors affecting gait speed in patients with type-2 diabetes mellitus (T2DM) without neuropathy. METHODS: This cross-sectional study enrolled 71 diabetic patients without neuropathy (mean age 55.87 ± 7.74 years, 85.9% women). Neuropathy status was assessed with Douleur Neuropathique 4. We used a cut-off point for gait speed of 1 m/s to classify the participants into two groups: slow walkers (SW) and average and brisk walkers (ABW). The groups were compared in terms of age, sex, body mass index (BMI), hemoglobin A1c (HbA1c), fasting glucose, systolic blood pressure, maximal aerobic capacity (VO(2)max), percentage of muscle mass, percentage of lower extremity muscle mass, Mini-Mental State Examination (MMSE) score, and years of education. RESULTS: Compared with the ABW group, the SW group had significantly lower VO(2)max (14.49 ± 2.95 vs 16.25 ± 2.94 mL/kg/min) and MMSE score (25.01 ± 3.21 vs 27.35 ± 1.97), fewer years of education, and these patients were more frequently women (P < 0.05). In the multivariate regression models, the combination of VO(2)max, sex, and MMSE score explained only 23.5% of gait speed (P < 0.001). MMSE score and VO(2)max independently determined gait speed after adjustment for age, BMI, HbA1c, fasting glucose, systolic blood pressure, percent of muscle mass, percent of lower extremity muscle mass, and years of education. CONCLUSION: In diabetic patients without neuropathy, physical impairment and disability could be prevented by an improvement in aerobic capacity and cognitive function. ClinicalTrials.gov number: NCT04758364