Salivary 1,5-Anhydroglucitol and AGEs Are Associated with Postural Instability in Diabetic Foot Patients

<i>Background and Objectives</i>: Gait and posture alterations are reported in patients with diabetic foot. We evaluated whether gait and postural parameters are associated with a well-known parameter, e.g., glycated hemoglobin levels in blood, and the salivary markers 1,5-anhydro-D-gluc...

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Main Authors: Lorenzo Brognara, Mar Sempere-Bigorra, Omar Cauli
Format: Article
Language:English
Published: MDPI AG 2025-05-01
Series:Medicina
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Online Access:https://www.mdpi.com/1648-9144/61/6/968
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author Lorenzo Brognara
Mar Sempere-Bigorra
Omar Cauli
author_facet Lorenzo Brognara
Mar Sempere-Bigorra
Omar Cauli
author_sort Lorenzo Brognara
collection DOAJ
description <i>Background and Objectives</i>: Gait and posture alterations are reported in patients with diabetic foot. We evaluated whether gait and postural parameters are associated with a well-known parameter, e.g., glycated hemoglobin levels in blood, and the salivary markers 1,5-anhydro-D-glucitol (1,5-AG) and Advanced Glycation End-Products (AGEs) measured in saliva samples. <i>Materials and Methods</i>: Gait and postural impairment was assessed using a wearable inertial sensor, and the evaluation of balance/gait and risk of fall was determined by the Tinetti Scale and Downton Index, respectively. Glycemic control was measured by glycated hemoglobin concentration and fasting glycemia. The salivary concentration of 1,5-AG and AGEs was measured using an enzyme-linked immunosorbent assay. <i>Results</i>: Eighty-five patients were evaluated, revealing significant associations (<i>p</i> < 0.05) between salivary 1,5-AG and sway path displacement along the medio-lateral axis (rho = 0.365, <i>p</i> = 0.017) and sway area (rho = 0.334, <i>p</i> = 0.031) during tandem position tests with eyes closed. Salivary AGEs were significantly associated with sway path displacement along the anterior–posterior axis (rho = 0.419, <i>p</i> = 0.004) and medio-lateral axis (rho = 0.436, <i>p</i> = 0.002) in the tests performed with eyes closed, feet close together, and foam pads, as well as with sway area (rho = 0.387, <i>p</i> = 0.007). The concentration of HbA1c was significantly correlated with sway path displacement along the anterior–posterior axis in the tests performed with eyes closed, feet close together, and foam pads (rho = 0.236, <i>p</i> = 0.043), as well as with sway area (rho = −0.236, <i>p</i> = 0.043). A significant difference was observed in the salivary AGE concentration between patients with previous ulcers versus those without (<i>p</i> = 0.035). By applying Bonferroni correction for multiple comparisons, the associations remained significant (<i>p</i> < 0.05) for AGE concentration in saliva and postural instability parameters. <i>Conclusions</i>: The results suggest a link between salivary glycemic control biomarkers, in particular AGEs and postural changes in patients with diabetic foot, indicating a new interesting filed for further studies on fall risk.
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spelling doaj-art-8df8c15bc0ef4d968195a1397a8fc89e2025-08-20T03:16:19ZengMDPI AGMedicina1010-660X1648-91442025-05-0161696810.3390/medicina61060968Salivary 1,5-Anhydroglucitol and AGEs Are Associated with Postural Instability in Diabetic Foot PatientsLorenzo Brognara0Mar Sempere-Bigorra1Omar Cauli2Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40100 Bologna, ItalyNursing Department, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, SpainNursing Department, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain<i>Background and Objectives</i>: Gait and posture alterations are reported in patients with diabetic foot. We evaluated whether gait and postural parameters are associated with a well-known parameter, e.g., glycated hemoglobin levels in blood, and the salivary markers 1,5-anhydro-D-glucitol (1,5-AG) and Advanced Glycation End-Products (AGEs) measured in saliva samples. <i>Materials and Methods</i>: Gait and postural impairment was assessed using a wearable inertial sensor, and the evaluation of balance/gait and risk of fall was determined by the Tinetti Scale and Downton Index, respectively. Glycemic control was measured by glycated hemoglobin concentration and fasting glycemia. The salivary concentration of 1,5-AG and AGEs was measured using an enzyme-linked immunosorbent assay. <i>Results</i>: Eighty-five patients were evaluated, revealing significant associations (<i>p</i> < 0.05) between salivary 1,5-AG and sway path displacement along the medio-lateral axis (rho = 0.365, <i>p</i> = 0.017) and sway area (rho = 0.334, <i>p</i> = 0.031) during tandem position tests with eyes closed. Salivary AGEs were significantly associated with sway path displacement along the anterior–posterior axis (rho = 0.419, <i>p</i> = 0.004) and medio-lateral axis (rho = 0.436, <i>p</i> = 0.002) in the tests performed with eyes closed, feet close together, and foam pads, as well as with sway area (rho = 0.387, <i>p</i> = 0.007). The concentration of HbA1c was significantly correlated with sway path displacement along the anterior–posterior axis in the tests performed with eyes closed, feet close together, and foam pads (rho = 0.236, <i>p</i> = 0.043), as well as with sway area (rho = −0.236, <i>p</i> = 0.043). A significant difference was observed in the salivary AGE concentration between patients with previous ulcers versus those without (<i>p</i> = 0.035). By applying Bonferroni correction for multiple comparisons, the associations remained significant (<i>p</i> < 0.05) for AGE concentration in saliva and postural instability parameters. <i>Conclusions</i>: The results suggest a link between salivary glycemic control biomarkers, in particular AGEs and postural changes in patients with diabetic foot, indicating a new interesting filed for further studies on fall risk.https://www.mdpi.com/1648-9144/61/6/968salivary biomarkersAGEsHbA1cbalancegaitinertial sensors
spellingShingle Lorenzo Brognara
Mar Sempere-Bigorra
Omar Cauli
Salivary 1,5-Anhydroglucitol and AGEs Are Associated with Postural Instability in Diabetic Foot Patients
Medicina
salivary biomarkers
AGEs
HbA1c
balance
gait
inertial sensors
title Salivary 1,5-Anhydroglucitol and AGEs Are Associated with Postural Instability in Diabetic Foot Patients
title_full Salivary 1,5-Anhydroglucitol and AGEs Are Associated with Postural Instability in Diabetic Foot Patients
title_fullStr Salivary 1,5-Anhydroglucitol and AGEs Are Associated with Postural Instability in Diabetic Foot Patients
title_full_unstemmed Salivary 1,5-Anhydroglucitol and AGEs Are Associated with Postural Instability in Diabetic Foot Patients
title_short Salivary 1,5-Anhydroglucitol and AGEs Are Associated with Postural Instability in Diabetic Foot Patients
title_sort salivary 1 5 anhydroglucitol and ages are associated with postural instability in diabetic foot patients
topic salivary biomarkers
AGEs
HbA1c
balance
gait
inertial sensors
url https://www.mdpi.com/1648-9144/61/6/968
work_keys_str_mv AT lorenzobrognara salivary15anhydroglucitolandagesareassociatedwithposturalinstabilityindiabeticfootpatients
AT marsemperebigorra salivary15anhydroglucitolandagesareassociatedwithposturalinstabilityindiabeticfootpatients
AT omarcauli salivary15anhydroglucitolandagesareassociatedwithposturalinstabilityindiabeticfootpatients