Diabetes related fatigue sarcopenia, frailty

Creatinine-to-body weight ratio is a predictor of incident diabetes: a population-based retrospective cohort study

PURPOSE

Creatinine to body weight (Cre/BW) ratio is considered the independent risk factor for incident type 2 diabetes mellitus (T2DM), but research on this relationship is limited. The relationship between the Cre/BW ratio and T2DM among Chinse individuals is still ambiguous. This study aimed to evaluate the correlation between the Cre/BW ratio and the risk of T2DM in the Chinese population.

METHODS

This is a retrospective cohort study from a prospectively collected database. We included a total of 200,658 adults free of T2DM at baseline. The risk of incident T2DM according to Cre/BW ratio was estimated using multivariable Cox proportional hazards models, and a two-piece wise linear regression model was developed to find out the threshold effect.

RESULTS

With a median follow-up of 3.13 ± 0.94 years, a total of 4001 (1.99%) participants developed T2DM. Overall, there was an L-shaped relation of Cre/BW ratio with the risk of incident T2DM (P for non-linearity < 0.001). When the Cre/BW ratio (× 100) was less than 0.86, the risk of T2DM decreased significantly as the Cre/BW ratio increased [0.01 (0.00, 0.10), P < 0.001]. When the Cre/BW ratio (× 100) was between 0.86 and 1.36, the reduction in the risk of developing T2DM was not as significant as before [0.22 (0.12, 0.38), P < 0.001]. In contrast, when the Cre/BW ratio (× 100) was greater than 1.36, the reduction in T2DM incidence became significantly flatter than before [0.73 (0.29,1.8), P = 0.49].

CONCLUSION

There was an L-shaped relation of Cre/BW ratio with incidence of T2DM in general Chinese adults. A negative curvilinear association between Cre/BW ratio and incident T2DM was present, with a saturation effect predicted at 0.86 and 1.36 of Cre/BW ratio (× 100).

Diagnosis of Muscle Fatigue Using Surface Electromyography and Analysis of Associated Factors in Type 2 Diabetic Patients with Neuropathy: A Preliminary Study

Diabetic neuropathy (DN) is a major complication associated with diabetes mellitus (DM) and results in fatigue. We investigated whether type 2 diabetic patients with or without neuropathy experienced muscle fatigue and determined the most influencing factor on muscle fatigue. Overall, 15 out of 25 patients with type 2 DM were diagnosed with DN using a nerve conduction study in the upper and lower extremities, and the composite score (CS) was calculated. We obtained the duration of DM and body mass index (BMI) from subjects, and they underwent a series of laboratory tests including HbA1c, fasting plasma glucose, triglycerides, and high- and low-density lipoprotein. To qualify muscle fatigue, this study used surface electromyography (sEMG). Anode and cathode electrodes were attached to the medial gastrocnemius. After 100% isometric maximal voluntary contracture of plantarflexion, the root mean square, median frequency (MDF), and mean power frequency (MNF) were obtained. We showed a correlation among laboratory results, duration of DM, BMI, CS, and parameters of muscle fatigue. The duration of DM was related to fatigue of the muscle and CS (p < 0.05). However, CS was not related to fatigue. The MDF and MNF of muscle parameters were positively correlated with HbA1c and fasting plasma glucose (p < 0.05). In conclusion, we suggest that the duration of DM and glycemic control play important roles in muscle fatigue in patients with DN. Additionally, sEMG is useful for diagnosing muscle fatigue in patients with DN.

An 'Ayurveda-Biology' platform for integrative diabetes management

ETHNOPHARMACOLOGICAL RELEVANCE

Diabetes is a multifactorial disease with complex multi-organ-multi-target crosstalk in the body. Currently, the theoretical assumptions framing the diabetes management strategies are reductionist and largely focus on reducing hyperglycemia through targeted molecular drugs. While they effectively reduce hyperglycemia, they are inadequate to address the multifactorial etiopathology, chronicity and systemic complications of diabetes. Therefore, a holistic and systemic approach is essential for its successful management. We hypothesize an integrative diabetes management strategy, combining holistic principles of diabetes management with its molecular understandings, would be more appropriate to fill this gap. The holistic disease management principles of Ayurveda, the Indian system of medicine, can play a pivotal role in this context. This narrative review discusses the scope of a trans-disciplinary ' Ayurveda-Biology ' approach for deepening the holistic understanding of the pathophysiology of diabetes as well as designing novel integrative strategies for managing diabetes and restoring whole body glucose homeostasis.

METHODOLOGY

The article analyses the Ayurveda scheme of diabetes management and correlates it with the molecular understanding of its pathophysiology and management. The sources of information used in this article include classical texts of Ayurveda , medical books, published research articles and scientific databases like PubMed, Google Scholar, Science-Direct, etc. RESULTS: While Ayurveda and modern biomedicine uses different epistemology and ontology for describing diabetes, both the systems recognize the central role of gut and gut derived factors in postprandial glucose disposal and whole body glucose homeostasis. Essentially, the principles of both Ayurveda and modern biomedicine overlap at a gut centred view of diabetes management; and Gastro-intestinal mediated glucose disposal , a holistic concept of glucose metabolism, is emerging as a converging node for designing innovative integrative diabetes management strategies.

CONCLUSIONS

An integrative disease management strategy, combining holistic and reductionist perspectives of traditional medicine and biology respectively, would be the prerogative for successful management of diabetes. Creating an ' Ayurveda-Biology' knowledge framework integrating the patient centred holistic management principles of Ayurveda and the molecular approaches of modern biology can give better insights into the biology of whole body glucose homeostasis and offer novel strategies for cost effective, holistic and multi-targeted management of diabetes.

Creatinine to Body Weight Ratio Is Associated with Incident Diabetes: Population-Based Cohort Study

We investigated the association between creatinine to body weight (Cre/BW) ratio and incident diabetes. In this cohort study, 9659 men and 7417 women were follow up mean (SD) 5.6 (3.5) years and 5.4 (3.4) years, respectively. For men, tertile 1 (T1; n = 3176), Cre/BW < 0.01275; tertile 2 (T2; n = 3258), 0.01275 ≤ Cre/BW < 0.0148; and tertile 3 (T3; n = 3225), Cre/BW ≥ 0.0148; and for women, T1 (n = 2437), Cre/BMI < 0.0118; T2 (n = 2516), 0.0118 ≤ Cre/BMI < 0.014; and T3 (n = 2477), Cre/BMI ≥ 0.014. Among them, 362 men and 102 women developed diabetes. The hazard ratios (HRs) of incident diabetes in the T2 group was 0.56 (95% CI 0.44–0.71, p < 0.001) in men and 0.61 (0.38–0.99, p = 0.045) in women and in the T3 group was 0.42 (0.32–0.54, p < 0.001) in men and 0.55 (0.34–0.89, p = 0.014) in women after adjusting for covariates, compared with the T1 group. Moreover, Δ0.001 incremental of Cre/BW is negatively associated with incident diabetes (adjusted HR 0.84, 95% CI 0.80–0.88, p < 0.001 for men and 0.88, 0.81–0.96, p = 0.003 for women). In conclusion, Cre/BW ratio is inversely related to incident diabetes. Checking Cre/BW ratios may predict future diabetes risks.

Obesity, but not metabolic control, is associated with muscle strength and endurance in diabetic older adults

OBJECTIVE

The objective of this study is to investigate the association between muscle function, body composition, and metabolic control in adults with type 2 diabetes mellitus (DM2).

METHODS

Forty-eight individuals with DM2 were divided into four groups according to the severity of obesity (body mass index [BMI]: lean [LN, n = 10], overweight [OW, n = 16], obese class I [OBI, n = 15], and obese class II [OBII, n = 7]). Absolute peak torque (TQ), relative peak torque (TQ/body weight [BW]), total work (TW), and fatigue index (FI) were assessed by means of an isokinetic dynamometer during concentric knee extensor contraction. Spearman's correlation coefficients were used to estimate the association between measurements.

RESULTS

Although OBII had higher insulin levels than both LN and OW groups, no significant differences were found between groups for TQ, TQ/BW, TW, and FI, as well as between metabolic variables and muscle measurements. There was a positive correlation between BMI and TQ (r_s = .45) and resistance tests, between BMI and TQ (r_s = .43), and TW (r_s = .37).

CONCLUSION

Metabolic variables do not correlate with muscle strength and endurance in DM2. However, severity of obesity measured by the BMI is positively associated with muscle force-generating capacity and endurance.