{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T17:16:07Z","timestamp":1788369367243,"version":"build-2803163510"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00c3fico e Tecnol\u00c3\u00b3gico","doi-asserted-by":"publisher","award":["407252\/2018-5"],"award-info":[{"award-number":["407252\/2018-5"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00c3fico e Tecnol\u00c3\u00b3gico","doi-asserted-by":"publisher","award":["302558\/2022-5"],"award-info":[{"award-number":["302558\/2022-5"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00c3fico e Tecnol\u00c3\u00b3gico","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study aimed to identify the predictive effects of different aspects of diabetic peripheral neuropathy (DPN) and other already known risk factors for falls through a comprehensive logistic model within community-dwelling older adults with diabetes and DPN. This paper also provides a model that estimates the probability of a fall occurring in a real-world clinical scenario.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional retrospective study analyzed data from subjects that had never fallen (non-fallers, n\u2009=\u2009534) and that had fallen at least twice in the previous year (fallers, n\u2009=\u2009101). The logistic regression analysis was performed on a training sample randomly extracted from the original sample (non-fallers: n\u2009=\u200985; fallers: n\u2009=\u200981). The model was validated by checking the performance parameters using a test sample comprised of 10% of fallers (n\u2009=\u200916) and a proportionate subsample of non-fallers (n\u2009=\u200985) from the original dataset.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Three predictive models were developed. The best model (0.762 receiver operating characteristic[ROC] curve area, 60.4% accuracy, 68.8% sensitivity, 58.8% specificity) identified age (odds ratio[OR]=1.06[95%CI: 1.02, 1.10],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002), Michigan Neuropathy Screening Instrument score (OR=1.23[95%CI: 1.08, 1.40],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.001), and self-reported balance problems (OR=2.65[95%CI: 1.29, 5.45],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.008) as predictors of falls. A second model with good performance parameters (0.750 ROC curve area, 62.4% accuracy, 62.5% sensitivity, 62.4% specificity) showed that age (OR=1.04[95%CI: 1.01, 1.07],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.015), balance problems (OR=3.29[95%CI: 1.64, 6.59],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.001), and DPN severity (OR=1.18[95%CI: 1.03, 1.34],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.018) were predictors of falls.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We showed the potential of a predictive model for recurrent falls based on commonly evaluated variables in community-dwelling individuals with diabetes for use in clinical practice. Even for individuals who are not at a high risk for falls, it is crucial to assess the combination of DPN signs, symptoms, and severity and the perception of balance problems, as these are more relevant in people with diabetes than the traditional physical impairments associated to aging.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0340262","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T18:46:35Z","timestamp":1767379595000},"page":"e0340262","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Predictive effects of diabetes-related risk factors for falls in community-dwelling people with diabetic peripheral neuropathy based on a logistic regression model"],"prefix":"10.1371","volume":"21","author":[{"given":"Eneida Yuri","family":"Suda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina Dallemole","family":"Sartor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anice de Campos","family":"Passaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricky","family":"Watari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eunice Young","family":"Docko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1254-0007","authenticated-orcid":true,"given":"Isabel C. N.","family":"Sacco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,1,2]]},"reference":[{"issue":"2","key":"pone.0340262.ref001","doi-asserted-by":"crossref","DOI":"10.2519\/jospt.2021.0301","article-title":"Physical therapy management of older adults with hip fracture","volume":"51","author":"CM McDonough","year":"2021","journal-title":"J Orthop Sports Phys Ther"},{"issue":"1","key":"pone.0340262.ref002","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.cger.2018.08.010","article-title":"Falls in the geriatric patient","volume":"35","author":"DJ Bolding","year":"2019","journal-title":"Clin Geriatr Med"},{"key":"pone.0340262.ref003","unstructured":"World Health Organization. Falls. 2021. [cited 2024 Aug 19]. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/falls"},{"key":"pone.0340262.ref004","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/1758-5996-6-65","article-title":"The effect on fall rate of blood glucose testing at the time of falls in elderly diabetics","volume":"6","author":"E Waclawski","year":"2014","journal-title":"Diabetol Metab Syndr"},{"key":"pone.0340262.ref005","doi-asserted-by":"crossref","first-page":"287","DOI":"10.2147\/CLEP.S66821","article-title":"Disease burden evaluation of fall-related events in the elderly due to hypoglycemia and other diabetic complications: a clinical review","volume":"6","author":"UH Malabu","year":"2014","journal-title":"Clin Epidemiol"},{"issue":"2","key":"pone.0340262.ref006","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/S0104-4230(12)70186-0","article-title":"Comparative analysis of risk for falls in patients with and without type 2 diabetes mellitus","volume":"58","author":"PP de Oliveira","year":"2012","journal-title":"Rev Assoc Med Bras (1992)"},{"issue":"5","key":"pone.0340262.ref007","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1093\/ageing\/afq081","article-title":"Diabetes, falls and fractures","volume":"39","author":"D Mayne","year":"2010","journal-title":"Age Ageing"},{"issue":"5","key":"pone.0340262.ref008","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1097\/EDE.0b013e3181e89905","article-title":"Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis","volume":"21","author":"S Deandrea","year":"2010","journal-title":"Epidemiology"},{"issue":"4","key":"pone.0340262.ref009","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1093\/ageing\/afv024","article-title":"Fear of falling is common in patients with type 2 diabetes and is associated with increased risk of falls","volume":"44","author":"D Bruce","year":"2015","journal-title":"Age Ageing"},{"issue":"9","key":"pone.0340262.ref010","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.4158\/EP171794.RA","article-title":"Aging, diabetes, and falls","volume":"23","author":"AI Vinik","year":"2017","journal-title":"Endocr Pract"},{"issue":"12","key":"pone.0340262.ref011","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1093\/gerona\/60.12.1539","article-title":"Risk factors for falls in older disabled women with diabetes: the women\u2019s health and aging study","volume":"60","author":"S Volpato","year":"2005","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"pone.0340262.ref012","first-page":"6679","article-title":"Effect of gender and diabetes on major depressive disorder using heart rate asymmetry","volume":"2014","author":"CK Karmakar","year":"2014","journal-title":"Annu Int Conf IEEE Eng Med Biol Soc"},{"issue":"11","key":"pone.0340262.ref013","doi-asserted-by":"crossref","first-page":"1983","DOI":"10.2337\/diacare.25.11.1983","article-title":"Incidence of falls, risk factors for falls, and fall-related fractures in individuals with diabetes and a prior foot ulcer","volume":"25","author":"C Wallace","year":"2002","journal-title":"Diabetes Care"},{"issue":"1","key":"pone.0340262.ref014","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.gaitpost.2009.09.005","article-title":"Patients with type II diabetes mellitus display reduced toe-obstacle clearance with altered gait patterns during obstacle-crossing","volume":"31","author":"M-W Liu","year":"2010","journal-title":"Gait Posture"},{"issue":"6","key":"pone.0340262.ref015","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1038\/ncpneuro0504","article-title":"Diabetic neuropathy--a review","volume":"3","author":"G Said","year":"2007","journal-title":"Nat Clin Pract Neurol"},{"issue":"4","key":"pone.0340262.ref016","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1080\/00222895.1989.10735488","article-title":"Biomechanics of normal and pathological gait: implications for understanding human locomotor control","volume":"21","author":"DA Winter","year":"1989","journal-title":"J Mot Behav"},{"issue":"2","key":"pone.0340262.ref017","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1007\/BF00231254","article-title":"Gating and reversal of reflexes in ankle muscles during human walking","volume":"82","author":"J Duysens","year":"1990","journal-title":"Exp Brain Res"},{"issue":"1","key":"pone.0340262.ref018","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/S0966-6362(03)00095-X","article-title":"Reduced plantar sensation causes a cautious walking pattern","volume":"20","author":"E Eils","year":"2004","journal-title":"Gait Posture"},{"issue":"8","key":"pone.0340262.ref019","doi-asserted-by":"crossref","first-page":"2477","DOI":"10.1007\/s00221-015-4318-5","article-title":"Baseline skin information from the foot dorsum is used to control lower limb kinematics during level walking","volume":"233","author":"EE Howe","year":"2015","journal-title":"Exp Brain Res"},{"issue":"9","key":"pone.0340262.ref020","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/S0268-0033(01)00090-0","article-title":"The effect of changes in foot sensation on plantar pressure and muscle activity","volume":"16","author":"MA Nurse","year":"2001","journal-title":"Clin Biomech (Bristol)"},{"key":"pone.0340262.ref021","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.gaitpost.2019.09.014","article-title":"Impact of diabetic neuropathy severity on foot clearance complexity and variability during walking","volume":"74","author":"EY Suda","year":"2019","journal-title":"Gait Posture"},{"issue":"10","key":"pone.0340262.ref022","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1111\/j.1464-5491.2009.02811.x","article-title":"Clinical factors associated with gait alterations in diabetic patients","volume":"26","author":"L Allet","year":"2009","journal-title":"Diabet Med"},{"issue":"5","key":"pone.0340262.ref023","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1001\/jama.2016.7653","article-title":"Logistic regression: relating patient characteristics to outcomes","volume":"316","author":"J Tolles","year":"2016","journal-title":"JAMA"},{"issue":"10","key":"pone.0340262.ref024","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.2337\/diacare.25.10.1749","article-title":"Older women with diabetes have a higher risk of falls: a prospective study","volume":"25","author":"AV Schwartz","year":"2002","journal-title":"Diabetes Care"},{"issue":"2","key":"pone.0340262.ref025","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1111\/j.1464-5491.2009.02914.x","article-title":"Lower-limb risk factors for falls in people with diabetes mellitus","volume":"27","author":"C Macgilchrist","year":"2010","journal-title":"Diabet Med"},{"issue":"1","key":"pone.0340262.ref026","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1007\/s11657-018-0475-z","article-title":"Severe hypoglycemia is associated with high risk for falls in adults with type 1 diabetes","volume":"13","author":"VN Shah","year":"2018","journal-title":"Arch Osteoporos"},{"key":"pone.0340262.ref027","doi-asserted-by":"crossref","first-page":"107930","DOI":"10.1016\/j.diabres.2019.107930","article-title":"Balance, risk of falls, risk factors and fall-related costs in individuals with diabetes","volume":"158","author":"WD Rinkel","year":"2019","journal-title":"Diabetes Res Clin Pract"},{"issue":"3","key":"pone.0340262.ref028","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.bjpt.2017.10.004","article-title":"Cross-cultural adaptation and measurement properties of the Brazilian Version of the Michigan Neuropathy Screening Instrument","volume":"22","author":"CD Sartor","year":"2018","journal-title":"Braz J Phys Ther"},{"issue":"1","key":"pone.0340262.ref029","article-title":"Use of artificial intelligence methods for classifying diabetic patients with polyneuropathy","volume":"7","author":"AA Gomes","year":"2015","journal-title":"Diabetol Metab Syndr"},{"key":"pone.0340262.ref030","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/1743-0003-11-11","article-title":"Effect of diabetic neuropathy severity classified by a fuzzy model in muscle dynamics during gait","volume":"11","author":"R Watari","year":"2014","journal-title":"J Neuroeng Rehabil"},{"key":"pone.0340262.ref031","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1002\/dmrr.2253","article-title":"Practical guidelines on the management and prevention of the diabetic foot 2011","volume":"28","author":"International Working Group on Diabetic Foot Editorial Board","year":"2012","journal-title":"Diabetes Metab Res Rev"},{"issue":"2","key":"pone.0340262.ref032","doi-asserted-by":"crossref","first-page":"250","DOI":"10.2337\/diacare.24.2.250","article-title":"Simple screening tests for peripheral neuropathy in the diabetes clinic","volume":"24","author":"BA Perkins","year":"2001","journal-title":"Diabetes Care"},{"issue":"6","key":"pone.0340262.ref033","doi-asserted-by":"crossref","DOI":"10.1093\/geronj\/45.6.M192","article-title":"Functional reach: a new clinical measure of balance","volume":"45","author":"PW Duncan","year":"1990","journal-title":"J Gerontol"},{"issue":"3","key":"pone.0340262.ref034","doi-asserted-by":"crossref","DOI":"10.1093\/geronj\/47.3.M93","article-title":"Functional reach: predictive validity in a sample of elderly male veterans","volume":"47","author":"PW Duncan","year":"1992","journal-title":"J Gerontol"},{"issue":"1","key":"pone.0340262.ref035","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s12864-019-6413-7","article-title":"The advantages of the Matthews correlation coefficient (MCC) over F1 score and accuracy in binary classification evaluation","volume":"21","author":"D Chicco","year":"2020","journal-title":"BMC Genomics"},{"issue":"3","key":"pone.0340262.ref036","doi-asserted-by":"crossref","DOI":"10.1002\/dmrr.3652","article-title":"Prevention of foot ulcers in persons with diabetes at risk of ulceration: A systematic review and meta-analysis","volume":"40","author":"JJ van Netten","year":"2024","journal-title":"Diabetes Metab Res Rev"},{"issue":"3","key":"pone.0340262.ref037","doi-asserted-by":"crossref","DOI":"10.1002\/dmrr.3649","article-title":"Clinical and biomechanical effectiveness of foot-ankle exercise programs and weight-bearing activity in people with diabetes and neuropathy: A systematic review and meta-analysis","volume":"40","author":"JJ van Netten","year":"2024","journal-title":"Diabetes Metab Res Rev"},{"issue":"5","key":"pone.0340262.ref038","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1007\/s40279-021-01596-6","article-title":"Exercise and neuropathy: systematic review with meta-analysis","volume":"52","author":"F Streckmann","year":"2022","journal-title":"Sports Med"},{"issue":"4","key":"pone.0340262.ref039","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1177\/1932296817695338","article-title":"Using plantar electrical stimulation to improve postural balance and plantar sensation among patients with diabetic peripheral neuropathy: a randomized double blinded study","volume":"11","author":"B Najafi","year":"2017","journal-title":"J Diabetes Sci Technol"},{"issue":"2","key":"pone.0340262.ref040","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.1007\/s40200-020-00652-8","article-title":"The efficacy of physiotherapy interventions in mitigating the symptoms and complications of diabetic peripheral neuropathy: A systematic review","volume":"19","author":"N Jahantigh Akbari","year":"2020","journal-title":"J Diabetes Metab Disord"},{"key":"pone.0340262.ref041","article-title":"The global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017","volume":"26","author":"SL James","year":"2020","journal-title":"Inj Prev"},{"issue":"6","key":"pone.0340262.ref042","article-title":"An \u201cImportance\u201d map of signs and symptoms to classify diabetic polyneuropathy: an exploratory data analysis","volume":"10","author":"ICN Sacco","year":"2015","journal-title":"PLoS One"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0340262","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T18:46:42Z","timestamp":1767379602000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0340262"}},"subtitle":[],"editor":[{"given":"Fredirick Lazaro","family":"mashili","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1,2]]},"references-count":42,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0340262","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,2]]}}}