Vestibular and Balance Considerations in Type 2 Diabetes: A Tutorial on Pertinent Areas and Issues

The purpose of this study is to describe the effects of diabetes mellitus (DM) on vestibular and balance system functions in humans. Because Type 2 diabetes (T2D) represents the majority of individuals affected by this condition, this subgroup is the main focus of this tutorial.

Evidence of dysfunction is based on epidemiological, anatomical, physiological, neuroimaging, and clinical findings. Preventative measures, therapeutic interventions, and other mitigating factors are also given consideration.

Experimental and clinical findings support the notion that T2D damages vestibular and balance systems to the extent that these effects are more prevalent in patients with higher blood glucose levels and longer duration of the disease. Evidence indicates that T2D increases the occurrence and re-occurrence rates of benign paroxysmal positional vertigo, particularly when it occurs in conjunction with hypertension, osteoarthritis, and otologic disorders like Ménière's disease. Type 2 diabetes also impairs vestibular compensation, which is exacerbated by disease duration. Investigational and clinical studies suggest that galvanic stimulation of the vestibular system can be effective in reducing blood glucose levels and improving rehabilitation outcomes.

Because DM is a chronic metabolic condition affecting cochlear, vestibular, and balance system functions, lowering blood glucose levels through diet, pharmacological interventions, and exercise can be effective in mitigating dysfunction.