Vestibular evoked potential response in adults with type 1 diabetes

Purpose: Vestibular system is critical for maintaining balance. This study aimed to determine the function of the saccule of the otolith organ in adults with type 1 diabetes (T1D) using cervical vestibular evoked myogenic potential (cVEMP) and its independently associated demographic, clinical and laboratory variables. Method: This case-control cross-sectional study included 60 patients (male = 15; female = 45) and 30 healthy adults. They underwent cVEMP. Results: Patients had mean age of 30.63 +/- 4.20 years and duration of illness of 14.68 +/- 3.65 years. More than 50% had frequent diabetic ketoacidosis (DKA), 30% had frequent hypoglycaemic attack, 35% had comorbid hyperlipidaemia, and 40% had peripheral neuropathy. Dizziness was reported in 30%. Compared to controls, 40% of patients had significantly delayed absolute latencies of P1 and N1 (p = 0.01) either unilateral or bilateral and 80% had reduced P1-N1 amplitudes (p = 0.001). Higher frequencies of abnormalities were present bilaterally. Asymmetry ratio (AR) was reported in 25%. Patients with longer duration of diabetes (>5 year), dizziness, HbA1c (>7%), frequent DKA or hypoglycaemic attacks and peripheral neuropathy had significantly prolonged P1 and N1 latencies and reduced P1-N1 amplitudes compared to those with shorter duration of diabetes, without dizziness, with HbA1c% <= 7%, low frequency of DKA hypoglycaemic attacks and those without peripheral neuropathy. Multiple regression analysis showed that presence of delayed P1 latencies and reduced P1-N1 amplitudes were significantly correlated with duration of diabetes > 5 years [OR = 3.60 (95%CI = 1.80-6.44), p = 0.01; OR = 4.56 (95%CI = 2.80-7.80), p = 0.01] and HbA1c levels >7% [OR = 5.26(95%CI = 3.83-8.05), p = 0.001; OR = 4.55(95%CI = 2.45-8.55), p = 0.001]. Conclusion: dysfunctions of the saccule of otolith organ and/or its pathway are prevalent in adults with T1D and correlated with duration and severity of diabetes. Therefore, optimal control of glycemic control is essential.