A cross-sectional analysis was conducted to characterize otolith dysfunction of the peripheral vestibular system and its functional impact in people with diabetes mellitus (DM). The study, published in the Diabetes Research and Clinical Practice, included 68 participants categorized into three groups: DM with peripheral neuropathy (DMPN), DM without peripheral neuropathy, and controls. Participant characteristics, including age, HbA1c, and clinical measures of peripheral neuropathy (PN), were collected.

Vestibular function was assessed using cervical vestibular evoked myogenic potentials (cVEMP; saccule pathway) and ocular vestibular evoked myogenic potentials (oVEMP; utricle pathway), evaluating interamplitude and absent response counts. Functional performance was measured using the Functional Gait Assessment and physical activity through activity watch step counts.
Worse PN severity predicted abnormal utricle and saccule function (odds ratio range 1.1–1.7; p≤0.05). Utricle dysfunction was more pronounced (p≤0.04) and more frequently absent among individuals with DMPN. Participants with absent utricle responses demonstrated poorer balance and lower physical activity levels (p≤0.03), whereas absent saccule responses were not associated with these functional outcomes.

These findings indicate that clinical measures of PN are associated with otolith dysfunction, particularly affecting the utricle, with corresponding balance and activity impairments. The cross-sectional design limits causal inference, and findings should be interpreted within this context.

Clinical measures of PN may provide a rationale for vestibular testing in people with DM who exhibit imbalance and reduced physical activity. Further longitudinal research is warranted to clarify temporal relationships.