Improvement Through Movement - Balance Control and Somatosensory Function in People With Diabetes Mellitus Type 2

Diabetes mellitus type 2 (DMT2) is the most common form of diabetes, typically occurringafter the age of 40. Insulin resistance, reduced insulin secretion, or a combination ofboth underlie the disease, resulting in elevated blood sugar levels (hyperglycemia). Thedevelopment of DMT2 is attributed to a lifestyle characterized by reduced physicalactivity, sedentary behavior, and poor dietary habits, leading to an increased body fatpercentage, particularly through the accumulation of visceral adipose tissue. Prolongedfatty acid concentrations and hormonal imbalances result in oxidative stress, whichdisrupts the environment responsible for the body's sensitivity to insulin. Consequently,insulin resistance develops, and over time, reduced insulin secretion occurs due to theexhaustion of pancreatic β‐cells. Risk factors for DMT2 include being overweight,obesity, metabolic disturbances (dyslipidemia, high blood pressure, hyperglycemia), andsmoking. It is estimated that 8% of the Belgian population is affected by DMT2, apercentage expected to increase in the future (1). Individuals with DMT2 may developdiabetic complications if blood sugar levels (especially hyperglycemia) remainuncontrolled. At the time of diagnosis, 30% of patients already experience complications(2). After more than 10 years of diagnosis, the risk of damage to large and/or smallblood vessels (angiopathy) increases. Common complications include damage to smallvessels in the eyes (retinopathy) and diabetic neuropathy, which can impair tactilesensation (perception of touch/pressure) and vibratory sense (perception of vibrations)(3‐5).Physical activity has long been recognized as a key intervention for improving variousdiabetes‐related characteristics in individuals with DMT2, such as insulin sensitivityand glucose control. Studies have shown that both aerobic (endurance) training andstrength training contribute to better blood sugar regulation and overall health. Theseforms of physical activity not only improve muscle mass but also enhance cardiovascularhealth and endurance, benefiting the overall physical fitness of individuals with DMT2.Although these general exercise interventions are effective, it remains unclear whetherthey are sufficient to address specific balance issues in this population. As balancecontrol depends on a complex integration of somatosensory input, muscle strength, andcoordination, the question arises whether adding targeted balance exercises to anexercise program is necessary to improve balance control.This study investigates whether a standard exercise program consisting of aerobictraining and strength training, in line with international guidelines, is sufficient toimprove balance control in older adults with DMT2, or whether specific balance exercisesare necessary. The distinction between the intervention and control groups allows for theevaluation of the relative impact of balance exercises. These findings could contributeto a more targeted and efficient approach to addressing balance problems in thispopulation.