{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T20:56:36Z","timestamp":1762376196992},"reference-count":31,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,2,9]],"date-time":"2017-02-09T00:00:00Z","timestamp":1486598400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["5RO1 NS46259\u201003"],"award-info":[{"award-number":["5RO1 NS46259\u201003"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008664","name":"Juvenile Diabetes Research Foundation","doi-asserted-by":"publisher","award":["5\u20102002\u2010185"],"award-info":[{"award-number":["5\u20102002\u2010185"]}],"id":[{"id":"10.13039\/100008664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet. Med."],"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>To investigate alterations in walking strategy and dynamic sway (unsteadiness) in people with impaired glucose tolerance and people with Type 2 diabetes in relation to severity of neuropathy and vitamin D levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 20 people with Type 2 diabetes, 20 people with impaired glucose tolerance and 20 people without either Type 2 diabetes or impaired glucose tolerance (control group) underwent gait analysis using a motion analysis system and force platforms, and detailed assessment of neuropathy and serum 25 hydroxy\u2010vitamin D levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ankle strength (<jats:italic>P<\/jats:italic> = 0.01) and power (<jats:italic>P<\/jats:italic> = 0.003) during walking and walking speed (<jats:italic>P<\/jats:italic> = 0.008) were preserved in participants with impaired glucose tolerance but significantly lower in participants with Type 2 diabetes compared with control participants; however, step width (<jats:italic>P<\/jats:italic> = 0.005) and dynamic medio\u2010lateral sway (<jats:italic>P<\/jats:italic> = 0.007) were significantly higher and posterior maximal movement (<jats:italic>P<\/jats:italic> = 0.000) was lower in participants with impaired glucose tolerance, but preserved in those with Type 2 diabetes compared with the control group. Dynamic medio\u2010lateral sway correlated with corneal nerve fibre length (<jats:italic>P<\/jats:italic> = 0.001) and corneal nerve branch density (<jats:italic>P<\/jats:italic> = 0.001), but not with vibration perception threshold (<jats:italic>P<\/jats:italic> = 0.19). Serum 25 hydroxy\u2010vitamin D levels did not differ significantly among the groups (<jats:italic>P<\/jats:italic> = 0.10) and did not correlate with any walking variables or measures of dynamic sway.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Early abnormalities in walking strategy and dynamic sway were evident in participants with impaired glucose tolerance, whilst there was a reduction in ankle strength, power and walking speed in participants with Type 2 diabetes. Unsteadiness correlated with small\u2010, but not large\u2010fibre neuropathy and there was no relationship between vitamin D levels and walking variables.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.13316","type":"journal-article","created":{"date-parts":[[2017,1,20]],"date-time":"2017-01-20T05:13:29Z","timestamp":1484889209000},"page":"839-845","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Altered walking strategy and increased unsteadiness in participants with impaired glucose tolerance and Type 2 diabetes relates to small\u2010fibre neuropathy but not vitamin D deficiency"],"prefix":"10.1111","volume":"34","author":[{"given":"M. M.","family":"Almurdhi","sequence":"first","affiliation":[{"name":"Centre for Endocrinology and Diabetes Institute of Human Development University of Manchester and Central Manchester NHS Foundation Trust Manchester Academic Health Science Centre Manchester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. J.","family":"Brown","sequence":"additional","affiliation":[{"name":"School of Healthcare Science Faculty of Science and Engineering Manchester Metropolitan University Manchester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F. L.","family":"Bowling","sequence":"additional","affiliation":[{"name":"Centre for Endocrinology and Diabetes Institute of Human Development University of Manchester and Central Manchester NHS Foundation Trust Manchester Academic Health Science Centre Manchester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. J. M.","family":"Boulton","sequence":"additional","affiliation":[{"name":"Centre for Endocrinology and Diabetes Institute of Human Development University of Manchester and Central Manchester NHS Foundation Trust Manchester Academic Health Science Centre Manchester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Jeziorska","sequence":"additional","affiliation":[{"name":"Centre for Endocrinology and Diabetes Institute of Human Development University of Manchester and Central Manchester NHS Foundation Trust Manchester Academic Health Science Centre Manchester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. A.","family":"Malik","sequence":"additional","affiliation":[{"name":"Centre for Endocrinology and Diabetes Institute of Human Development University of Manchester and Central Manchester NHS Foundation Trust Manchester Academic Health Science Centre Manchester UK"},{"name":"Weill\u2010Cornell Medicine\u2010Qatar Doha Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N. 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