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Author ORCID Identifier(s)

Dr Sheetal Malhan - ORCID ID  0000-0002-8363-306X

Dr Vishakha Daga - ORCID ID 0009-0006-5494-8763

Abstract

ABSTRACT

Background: Balance impairment in diabetes mellitus is predominantly driven by somatosensory loss secondary to peripheral neuropathy. The Berg Balance Scale (BBS) is widely used to evaluate functional balance, yet it mainly reflects motor performance and may not adequately represent sensory mechanisms. Following COVID-19, additional concerns regarding deconditioning have emerged, but interpretation depends on the measurement tool employed.

Objective: To examine the construct behavior and suitability of the BBS for assessing balance in individuals with diabetes with and without prior COVID-19 infection, and to determine whether the scale reflects known determinants of diabetic imbalance.

Methods: A cross-sectional analysis was conducted on 151 adults with diabetes (75 without COVID-19; 76 with prior COVID-19). Participants were assessed using the BBS. Associations between BBS scores and exercise habits, dietary adherence, and age were analyzed to explore construct validity. Independent t-tests and ANOVA were applied with significance at p<0.05.

Results: Mean BBS scores did not differ significantly between cohorts (p=0.22). Strong gradients were observed with exercise and dietary adherence (p<0.001), while relationships with factors presumed to be sensory in origin were limited. These patterns indicate that the BBS is responsive primarily to motor conditioning.

Conclusion: The BBS alone is insufficient as a comprehensive measure of balance impairment in diabetes because it underrepresents somatosensory dysfunction. An integrated assessment combining BBS with sensory instruments such as the MiniBEST or Michigan Neuropathy Screening Instrument is recommended.

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