Gait Characteristics Related to Fatigue in Patients With Type 2 Diabetes: Cross-Sectional Study

Aim This study aimed to determine the gait abnormalities associated with fatigue in patients with type 2 diabetes. Although walking is widely recommended as an effective form of exercise for diabetes management, many patients experience difficulty maintaining exercise routines due to fatigue. We hypothesized that patients with type 2 diabetes who experience fatigue during exercise would exhibit gait abnormalities that contribute to fatigue, such as abnormal increases or decreases in gait acceleration, particularly reduced regularity in vertical acceleration. Methods In this cross-sectional study, we recruited 50 patients with type 2 diabetes mellitus (mean age: 64.9 ± 12.0 years; BMI: 25.3 ± 4.6 kg/m²; 32 males and 18 females; HbA1c: 10.0 ± 2.2%) who were admitted to two hospitals in Japan for glycemic control between April 2020 and March 2021. Gait parameters were measured using a triaxial accelerometer during a 16-meter free walking test. Results Participants were divided into fatigue (n = 29; age: 60.7 ± 12.4 years; BMI: 26.4 ± 4.8 kg/m²) and no-fatigue (n=21; age: 70.8 ± 9.1 years; BMI: 23.8 ± 4.0 kg/m²) groups based on the Exercise Benefits and Barriers Scale. No significant differences were observed in the root mean square (RMS) or RMS ratio between the groups. Statistical analyses were conducted following normality confirmation using the Shapiro-Wilk test. The unpaired t-test and Wilcoxon signed-rank test were applied to normally and non-normally distributed data, respectively, and categorical variables were compared using the chi-square test. Multivariate logistic regression analysis was also performed. The vertical autocorrelation coefficient (ACVT), representing gait regularity, was significantly lower in the fatigue group compared to the no-fatigue group (p=0.044; CI: -0.05 to 0.00). Activity energy expenditure (AEE), calculated based on acceleration, BMI, and sex as a proxy for oxygen consumption, was significantly higher in the fatigue group (p=0.039; CI: 0.03 to 0.45). Multivariate analysis identified age (p=0.008; OR=0.916; CI: 0.84 to 0.98) and ACVT (p=0.038; OR=0.16; CI: 0.02 to 0.90) as significant factors. Conclusion These findings suggest that lower regularity of vertical acceleration during walking in patients with type 2 diabetes is a factor causing fatigue and may be a barrier to exercise continuation.