Gait characteristics in patients with type 2 diabetes; improvement after administration of rosiglitazone.

Background: Gait is impaired in people with type 2 diabetes. An insulin sensitizer, rosiglitazone(RSG) has promise to reverse some of the circulatory impairments seen in diabetes. The hypothesis to be tested was if RSG would improve gait in patients with diabetes.

Material/methods: Gait in 30 controls and 25 subjects with Type 2 diabetes was examined (10 subjects with diabetes were placed on rosiglitazone (4 mg/day) for 6 months, a PPAR-gamma ligand known to improve peripheral circulation, to asses any improvements in gait). Gait was analyzed by video, shoe sensors, accelerometers and electromyogram of the medial gastrocnemius and tibialis anterior muscles during the initiation of gait, steady state gait and turns.

Results: Subjects with diabetes had almost double the movement at the knee in both the flexion-extension and lateral directions than did control subjects. For example, for flexion-extension at the knee during constant velocity gait in a linear path, subjects with diabetes averaged a force of 1.91+/-0.29 g whereas control subjects only averaged 1.26+/-0.27 g, these differences were significant (p<0.01). Subjects with diabetes also showed greater muscle use (the average use of the tibiallis anterior muscle was 26.5+/-6.9% of total muscle activity for control subjects whereas subjects with diabetes averaged 59.6+/-14.9%).

Conclusions: These differences were reversed after 6 months administration of rosiglitazone. The results seem to imply that much of the impairment in gait is associated with cardiovascular insufficiency to the nervous system and/or muscle.