Diabetes and chronic kidney disease (CKD) are two distinct pathologies. The former is
defined as an impairment in insulin production and/or utilization, while the latter
refers to structural or functional abnormalities of the kidneys. However, these two
diseases share a common complication: peripheral neuropathy. This condition affects
between 50% and 60% of patients with diabetes or CKD.
Peripheral neuropathy involves the destruction of sensory and motor neurons, leading to a
wide range of painful symptoms while also reducing force production capacity. Among the
diagnostic tests used, the most accessible clinical tests suffer from high variability
due to human subjectivity (e.g., the tuning fork test, which requires examiner expertise
and verbal patient feedback), whereas laboratory electrophysiological tests can only
detect the largest neurons, which are affected at later stages. Although composite
clinical tests have been developed to improve neuropathy screening performance, they
still inherit the limitations of their individual components. In other words, they remain
subject to variability related to the examiner's experience and the patient's ability to
understand instructions, while also being performed through various procedures that lack
a standardized consensus. Moreover, these composite scores are particularly
time-consuming and are therefore rarely used in clinical practice. As a result, no method
currently allows for large-scale, early, and reliable screening of peripheral neuropathy.
Our recent work and emerging studies suggest that assessing functional capacities could
serve as an objective and early marker of neuropathic impairment, even before clinical
diagnosis. Specifically, the quantification of postural balance performance using
stabilometric methods (i.e., center of pressure displacement area) and unipedal balance
time could predict the presence of diabetes-related peripheral neuropathy with over 95%
accuracy compared to diagnosis with a composite clinical method (unpublished results).
Therefore, the aim of this study is to evaluate physical and balance capacities assessed
during routine care in adapted physical activity settings, in order to determine whether
the development of a composite score could help estimate the risk of peripheral
neuropathy in individuals with diabetes and CKD.