The association between handgrip strength and sleep duration in Japanese patients with type 2 diabetes

A Rare and Aggressive Case of Malignant Insulinoma

Insulinomas are rare pancreatic neuroendocrine tumors (NETs) characterized by autonomous insulin secretion leading to hypoglycemia. Malignant insulinomas are defined by the presence of metastases and present significant therapeutic challenges due to limited treatment options. We report the case of a 69-year-old woman with a two-month history of neuroglycopenic symptoms, including morning headaches, blurred vision, palpitations, and sweating, which were alleviated by sugar intake. An episode of severe hypoglycemia-induced unconsciousness necessitated intramuscular glucagon administration, resulting in regained consciousness. The combination of neuroglycopenic symptoms relieved by carbohydrate and documented hypoglycemia fulfilled Whipple's triad, prompting evaluation for an insulin-secreting tumor. Laboratory findings revealed elevated endogenous insulin and C-peptide levels, indicating hyperinsulinemia. Imaging studies, including contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI), identified a 25 mm solid lesion in the pancreatic body and multiple hepatic metastases. A ⁶⁸Ga-DOTA-NOC positron emission tomography (PET) scan demonstrated high somatostatin receptor expression in both the pancreatic lesion and hepatic metastases. Ultrasound-guided liver biopsy revealed a high-grade (G3) neuroendocrine carcinoma with a Ki-67 proliferation index exceeding 30%, confirming the diagnosis of malignant insulinoma. Multidisciplinary consultation recommended initiation of systemic chemotherapy with cisplatin and etoposide. Despite optimized medical management, including dextrose infusion, diazoxide, octreotide, and corticosteroids, the patient experienced persistent severe hypoglycemia. Transarterial chemoembolization (TACE) of the tumor vasculature was performed to mitigate hypoglycemia by reducing tumor burden. Post-procedure, the patient developed a cerebellar hemorrhage leading to coma and subsequent death. This case underscores the aggressive nature and poor prognosis associated with malignant insulinomas, particularly those with high proliferative indices. It highlights the complexities of managing refractory hypoglycemia in the context of widespread metastatic disease and emphasizes the urgent need for effective therapeutic strategies to improve patient outcomes.

Association between Sleep Duration and Grip Strength in U.S. Older Adults: An NHANES Analysis (2011-2014)

Handgrip strength has been shown an indispensable biomarker for older adults. Furthermore, the association between sleep duration and grip strength in special populations (e.g., type 2 diabetics) has been previously documented. However, the association between sleep duration and grip strength has been less studied in older adults and the dose-response relationship is unclear. Therefore, we drew 1881 participants aged 60 years and older from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 to explore their association and the dose-response relationship. Sleep duration was obtained through self-report. Grip strength data were obtained through a grip test using a handgrip dynamometer and divided into two categories: low grip strength and normal grip strength. Thus, dichotomized grip strength was used as a dependent variable. Poisson regression and restricted cubic spline were used for the main part of the analysis. We found that long sleep duration (≥9 h) was associated with a higher prevalence of low grip strength than the normal sleep duration (7-<9 h) group (IRR: 1.38, 95% CI: 1.12-1.69). Moreover, the gender-stratified analysis did not change the original results. This association was particularly pronounced and further strengthened among participants with normal weight (BMI < 25) (IRR: 2.30, 95% CI: 1.64-3.22) and participants aged 60-70 (IRR: 1.76, 95% CI: 1.40-2.22). In addition, with the increase in sleep duration, the multivariate-adjusted IRRs of low grip strength had a general downward trend at first, followed by a brief period of stability, and then presented an upward trend (p-value for non-linearity = 0.001). According to this study, we found that older adults who had long sleep duration had a higher risk of low grip strength. Muscle insulin utilization and muscle glucose metabolism are closely related to grip strength, so our research emphasizes the importance of maintaining normal sleep duration in older adults and suggests that older adults who sleep for a long period should pay more attention to their muscle health.

Association between Sleep Duration and Hand Grip Strength among COPD Patients

This study aimed to evaluate the association between night-time sleep duration and hand grip strength (HGS) among patients with chronic obstructive pulmonary disease (COPD). Participants aged ≥45 years were included in a nationally representative investigation clinical study in 2015. HGS was measured using dynamometers. The data on night-time sleep duration, sociodemographic information, and health-related variables were systematically collected. For analysis, sleep duration was categorized as <5 h, 5-7 h, 7 h, 7-9 h, and >9 h. Multivariable linear regression models were used to determine the possible association between the night-time sleep duration and HGS. Our results indicated that the shortest (<5 h) or the longest sleep duration (>9 h) was relevant to high risk of weaker HGS in females. In males, the shortest (<5 h) sleep duration was correlated to lower HGS. Thus, our findings clearly suggest that health care providers should focus on the potential influence of sleep duration on HGS among COPD patients.

What can hand grip strength tell us about type 2 diabetes?: mortality, morbidities and risk of diabetes

INTRODUCTION

Hand grip strength (HGS) has been determined as a simple and cost effective method for evaluating overall skeletal muscle strength and quality. It has been used in numerous clinical studies to examine the association between skeletal muscle and type 2 diabetes (T2D). Previous studies have shown that HGS is significantly associated with mortality and cardiovascular disease (CVD) in patients with T2D. As the prevalence of T2D has seen a steady increase globally, HGS measurement can be useful and essential in managing T2D.

AREAS COVERED

This narrative review summarizes the current evidence regarding the association between HGS and T2D. HGS has been considered a useful tool for identifying risks for T2D, CVD, and mortality and evaluating skeletal muscle strength and quality.

OPINION

HGS should be measured in all patients with T2D together with height, weight, and waist circumference. However, there is yet no standard method used in measuring for HGS. T2D patients with a low HGS can engage in resistance training more effectively with appropriate advice based on HGS. Future studies clarifying the genetic association between skeletal muscle and T2D are needed to provide individualized exercise therapy.