# Association between diabetes mellitus and impaired single-leg stance in patients with chronic liver disease: A cross-sectional study

## TL;DR

This study finds that diabetes is linked to worse balance in patients with chronic liver disease, with body water ratios and age being key predictors.

## Contribution

The study identifies a novel association between diabetes and impaired balance in chronic liver disease patients, highlighting the predictive role of body water ratios.

## Key findings

- Diabetic patients with chronic liver disease had significantly worse single-leg stance test results compared to non-diabetic patients.
- Age, body mass index, and extracellular water-to-total body water ratio were significant predictors of impaired balance.
- An extracellular water-to-total body water ratio of 0.393 best predicted impaired balance, indicating subclinical edema.

## Abstract

Diabetes mellitus (DM) is highly prevalent among patients with chronic liver disease (CLD) and is associated with disease progression and complications. However, the impact of DM on physical function, particularly balance, in patients with CLD remains unclear. The aim of this study was to investigate the association between DM and physical function in patients with CLD, with a specific focus on impaired single-leg stance test (SLST). This retrospective study analyzed the medical records of patients with CLD at Hiroshima University Hospital between 2014 and 2017. Logistic regression analysis was performed to identify factors associated with impaired SLST. Receiver operating characteristic curve analysis was conducted to determine cutoff values for predictive factors. The analysis included 152 patients with CLD, of whom 78% had comorbid DM. Patients with DM had a significantly higher prevalence of impaired SLST than those without DM (20% vs. 0%, p = 0.002, Cramer’s V 0.23). In 118 patients with CLD who had comorbid DM, age (odds ratio [OR] 1.089, 95% confidence interval [CI] 1.020–1.177, p = 0.009), body mass index (OR 1.176, 95% CI 1.045–1.343, p = 0.006), and extracellular water-to-total body water ratio (ECW/TBW) (OR 1.065, 95% CI 1.003–1.138, p = 0.039) were significant independent factors associated with impaired SLST (Nagelkerke pseudo-R² 0.31, p < 0.001). The ECW/TBW had the highest predictive accuracy, with a cutoff value of 0.393 (area under the curve = 0.733, sensitivity = 73.9%, specificity = 68.8%). DM was associated with impaired SLST in patients with CLD, suggesting a decline in balance. Age, body mass index, and ECW/TBW are significant predictors of impaired SLST. An ECW/TBW ratio of 0.393 indicates “subclinical” edema in patients with CLD and DM and should be considered in the assessment of fall risk.