Metabolic and Nutritional Characteristics in Middle-Aged and Elderly Sarcopenia Patients with Type 2 Diabetes

Exploring the relationship between glycemic variability and muscle dysfunction in adults with diabetes: A systematic review

This review is to systematically explore the relationship between muscle dysfunction and diabetes in adults, and to examine the impact of glycemic variability on muscle health and the development of diabetes-related complications. The review was conducted using three databases: MEDLINE, Scopus, and EMBASE, targeting peer-reviewed journal articles written in English and published from January 2014 to September 2024. The methodological quality assessment of the eligible studies was conducted using Joanna Briggs Institute Critical Appraisal Checklists. A total of 17 studies were included. Most studies were undertaken in Asian countries (n = 11) and focused on adults with type 2 diabetes (n = 12). There were 8,392 adults with diabetes, and their mean age ranged from 52 to 75 years old. The measurements for muscle function and glycemic variability varied across studies. The research findings regarding the relationship between muscle dysfunction and glycemic variability metrics among adults with diabetes, both with and without complications were inconsistent. For adults with diabetes and sarcopenic obesity, poor glycemic control was identified as an independent risk factor for sarcopenic obesity. Additionally, all included studies were rated as moderate or high quality in relation to their methodology. In conclusion, this review underscores the complex and inconsistent relationship between glycemic variability and muscle dysfunction in older adults with diabetes. Poor glycemic management is a significant risk factor for sarcopenic obesity, highlighting the need for tailored interventions to improve glycemic control and muscle health in this population.

Role of Medical Nutrition Therapy as Treatment of Sarcopenia in Older People with Type 2 Diabetes

BACKGROUND

Globally, the progressive increase in the aging population has led to social and health problems associated with age-related chronic diseases, such as type 2 diabetes mellitus (T2DM) and sarcopenia. Recent studies have highlighted that sarcopenia and diabetes have a bidirectional relationship. Nutritional therapy is a key element in the treatment of both sarcopenia and diabetes. To date, there are no nutritional guidelines for the management of sarcopenia in T2DM. The aim of this study was to evaluate the efficacy of a muscle-targeted nutritional intervention in older people with sarcopenia and type 2 diabetes based on the Italian nutrition guidelines.

METHODS

A total of 211 subjects (117 M and 94 F) affected by T2DM with a mean age of 74 ± 6.0 years were screened for sarcopenia, using EWGSOP2 diagnosis criteria, and enrolled to receive personalized dietary plans with two main targets: a daily energy intake of 25-30 kcal/kg body weight and a daily protein intake of at least 1.1-1.2 g/kg body weight.

RESULTS

In total, 34 subjects (24 M and 10 F) were sarcopenic with a prevalence of 16%, which was higher in men. After six months of treatment, handgrip strength increased by 0.83 kg (19.57 ± 5.70 kg vs. 20.40 ± 6.10 kg, p = 0.649), protein intake improved (0.91 ± 0.28 g/kg body weight vs. 1.03 ± 0.40 g/kg body weight, p = 0.115), and the glycated hemoglobin decreased (7.39 ± 0.49% to 6.82 ± 0.98%, p = 0.010). Seven younger subjects had an improvement of sarcopenia with a decrease in HbA1c (7.50 ± 0.59% vs. 6.91 ± 0.79, p = 0.19). The difference over time in the consumption of saturated fatty acids (OR 0.6, 95% CI 0.33-1.09, p = 0.096) and simple sugars (OR 0.91, 95% CI 0.80-1.01, p = 0.090) appeared to be associated with an improvement of sarcopenia status. A total of 177 subjects did not meet the criteria for a diagnosis of sarcopenia, and 148 subjects were assessed. The handgrip strength (26.22 ± 9.36 vs. 26.18 ± 9.24 kg, p0.974) and the glycated hemoglobin (7.21 ± 1.07 vs. 7.27 ± 0.98%, p = 0.735) remained stable over time, while protein intake at six months increased (0.81 ± 0.29 vs. 0.91 ± 0.29 g/kg body weight, p = 0.024). Four people were diagnosed with sarcopenia at follow-up, with a lower handgrip strength test result. These subjects were older and had worse glycemic control (HbA1c + 0.5%).

CONCLUSIONS

Lifestyle modification is important to prevent or reverse the development of the disease. Nutritional therapy in this population is therefore aimed at meeting all nutritional needs and promoting better glycemic control, in terms of glycated hemoglobin, in order to reduce the development of sarcopenia. Although promising, the intervention requires validation in larger studies with control groups.

Prevalence and risk factors of osteosarcopenia in elderly patients with uncontrolled type 2 diabetes

PURPOSE

To assess the prevalence of osteosarcopenia (OS) in elderly patients with type 2 diabetes mellitus (T2DM) and explore the related risk factors for developing this condition.

METHODS

This cross-sectional study enrolled hospitalized T2DM patients aged 60 years and older. Patients underwent assessments of total hip bone mineral density (BMD), grip strength, the Short Physical Performance Battery (SPPB), and body composition. Based on the 2019 Asian Working Group for Sarcopenia (AWGS) criteria, appendicular skeletal muscle mass (ASM), grip strength, and SPPB were measured to diagnose sarcopenia. BMD and T values of the lumbar spine and hip were measured using dual-energy X-ray absorptiometry (DXA). Osteosarcopenia was defined when both sarcopenia and osteoporosis criteria were met. Statistical analysis included binary logistic regression to identify significant risk factors.

RESULTS

A total of 254 hospitalized T2DM patients (80 males and 174 females) were included. They were divided into T2DM-OS (n = 58) and T2DM-NOS (n = 196) groups based on the presence of osteosarcopenia. The average ages were 72.724 ± 6.463 and 69.265 ± 6.035 years, respectively. The prevalence of osteosarcopenia in T2DM patients was 22.8%, with 20.7% (12 males) and 79.3% (46 females) in the T2DM-OS group. After adjusting for confounding factors, it was found that male gender (OR: 5.738, 95% CI: 1.602-20.551, P = 0.007), fasting plasma glucose (OR: 0.904, 95% CI: 0.821-0.995, P = 0.038), and ASMI (OR: 0.049, 95% CI: 0.013-0.184, P < 0.001) were major influencing factors for the development of osteosarcopenia in elderly T2DM patients.

CONCLUSIONS

The prevalence of T2DM-OS is relatively high, with male gender, low fasting plasma glucose, and low ASMI identified as risk factors.

Skeletal Muscle Mass Loss and Physical Function in Young to Middle-Aged Adult Patients With Diabetes: Cross-Sectional Observational Study

BACKGROUND

Recently, it has been reported that older adults with type 2 diabetes mellitus (T2DM) have lower skeletal muscle mass than healthy individuals. Although skeletal muscle mass in older adults with diabetes is occasionally reported, similar reports on young to middle-aged adults are limited.

OBJECTIVE

This study aims to assess the prevalence of skeletal muscle loss in young to middle-aged adults with diabetes, examine the relationship between skeletal muscle loss and physical function in these patients, and examine whether there are differences in these characteristics between men and women.

METHODS

This cross-sectional, observational study included patients younger than 65 years with T2DM who were admitted to our hospital between 2014 and 2022 for educational admission for glycemic control and requested rehabilitation by the Department of Metabolic Medicine. The control group consisted of patients who received rehabilitation during their hospitalization at our hospital and did not have diabetes. The main parameters included skeletal muscle mass, muscle strength, physical function, and activities of daily living.

RESULTS

The prevalence of skeletal muscle mass loss in this study was 18.2% (10/55) in men and 7.7% (4/52) in women. The skeletal muscle mass index (SMI) was 7.7 (SD 0.8) and 8.4 (SD 0.5) for men in the T2DM and control groups, respectively, and 7.0 (SD 0.9) and 6.8 (SD 0.7) for women in the T2DM and control groups, respectively. Therefore, compared with the nondiabetes group, a significant difference was observed in men but not in women (men: P<.001, women: P=.35). Nonetheless, the diabetes group exhibited significantly lower physical functions, such as a walking speed of 1.3 (SD 0.2) m/s and 1.2 (SD 0.43) m/s for men and women in the T2DM group and 1.6 (SD 0.2) m/s and 1.5 (SD 0.1) m/s for men and women in the control group, respectively (men: P<.001, women: P<.001). One-leg standing time was measured as 30.7 (SD 26.9) seconds and 29.4 (SD 25.5) seconds for men and women in the T2DM group, compared with 100.5 (SD 30.6) seconds and 82.5 (SD 39.8) seconds for men and women in the control group, respectively, with the T2DM group's times being significantly lower (men: P<.001, women: P<.001). Univariate logistic regression analysis showed that SMI was significantly associated with age, BMI, and peripheral neuropathy (all P≤.002). Multiple logistic regression analysis showed that BMI exhibited the strongest association (odds ratio 1.15, 95% CI 1.07-1.23; P<.001), and peripheral neuropathy was also significantly associated with SMI (P=.009).

CONCLUSIONS

Patients with diabetes, even those who are not older adults, face an elevated rate of skeletal muscle mass loss, muscle weakness, and a decline in physical function; moreover, they are susceptible to dynapenia and presarcopenia. Therefore, early intervention focusing on muscle evaluation and exercise is crucial.

Establishment and Validation of a Predictive Model for Sarcopenia Based on 2-D Ultrasound and Shear Wave Elastography in the Medial Gastrocnemius Muscle

OBJECTIVE

To develop and validate a predictive model for sarcopenia.

METHODS

A total of 240 subjects who visited our hospital between August 2021 and May 2023 were randomly divided by time of entry into a training set containing 2/3 of patients and a validation set containing 1/3 of patients. The muscle thickness (MT), echo intensity (EI), and shear wave velocity (SWV) of the medial gastrocnemius muscle were measured. Indicators that were meaningful in the univariate analysis in the training set were included in a binary logistic regression to derive a regression model, and the model was evaluated using a consistency index, calibration plot, and clinical validity curve. Diagnostic efficacy and clinical applicability were compared between the model and unifactorial indicators.

RESULTS

Four meaningful variables, age, body mass index (BMI), MT, and SWV, were screened into the predictive model. The model was Logit Y = 21.292 + 0.065 × Age - 0.411 × BMI - 0.524 × MT - 3.072 × SWV. The model was well differentiated with an internally validated C-index of 0.924 and an external validation C-index of 0.914. The calibration plot predicted probabilities against actual probabilities showed excellent agreement. The specificity, sensitivity, and Youden's index of the model were 73.80%, 97.40%, and 71.20%, respectively, when using the diagnostic cut-off value of >0.279 for sarcopenia. The logistic model had higher diagnostic efficacy (p < 0.001) and higher net clinical benefit (p < 0.001) over the same threshold range compared to indicators.

CONCLUSION

The logistic model of sarcopenia has been justified to have good discriminatory, calibrated, and clinical validity, and has higher diagnostic value than indicators.

Association between sarcopenia and hemoglobin level: a systematic review and meta-analysis

Background

Sarcopenia is a disease characterized by decreased skeletal muscle mass and function in elderly individuals. Decreased hemoglobin levels is a marker of anemia. According to reports, there may be an association between anemia and sarcopenia, but research is inconsistent. Therefore, this meta-analysis aims to explore the association between sarcopenia and low hemoglobin levels.

Methods

We searched PubMed, Embase, the Cochrane Library, Web of Science, Ovid, China National Knowledge Infrastructure (CNKI), and Wan Fang databases until September 2022. The present study included cross-sectional and case-control studies regarding low hemoglobin levels and sarcopenia. The studies were selected using inclusion and exclusion criteria. Studies were meta-analyzed by Review Manager 5.4 and Stata 16.0. We performed the heterogeneity test using the I 2 test. Subgroup analysis was carried out to explore the cause of heterogeneity. Egger test was used to evaluate publication bias.

Results

Out of 1,550 initial studies, 16 studies were meta-analyzed. Sarcopenia participants had significantly lower levels of hemoglobin than controls (MD = -0.53, 95% CI: -0.68 to -0.37, p < 0.001). Subgroup analysis, performed in China population reported lower hemoglobin levels in the sarcopenia population (MD = -0.49, 95% CI: -0.65 to -0.33, p < 0.001). And sarcopenia based on AWGS criteria reported lower hemoglobin levels (MD = -0.49, 95% CI: -0.65 to -0.33, p < 0.001). Among the population from hospitals and communities, patients with sarcopenia have lower hemoglobin levels.

Conclusion

Our meta-analysis found evidence that sarcopenia is associated with low hemoglobin levels. However, further large-scale prospective studies should be conducted in the future to further confirm our conclusions.

Systematic review registration

PROSPERO, CDR42024532252.

Unraveling the enigma of sarcopenia and sarcopenic obesity in Indian adults with type 2 diabetes - a comparative cross-sectional study

BACKGROUND

Sarcopenia and sarcopenic obesity are growing concerns associated with increasing diabetes incidence, but data from Indian diabetic cohorts are limited. This study examined the prevalence and clinical factors associated with sarcopenia and sarcopenic obesity.

METHODS

In this cross-sectional study, 750 participants aged 35-70 years were recruited by systematic stratification and a fixed quota sampling technique from medical camps and categorized into diabetic (n = 250), nondiabetic (n = 250), and obese nondiabetic (n = 250) groups. The assessments included questionnaires, muscle mass estimation by bioimpedance analysis, and blood tests. Sarcopenia was defined using the Asian Working Group consensus, and sarcopenic obesity was defined as sarcopenia with a BMI ≥ 25 kg/m2. Logistic regression was used to analyze risk factors.

RESULTS

Sarcopenia affected 60% of diabetic patients, 28% of nondiabetic patients, and 38% of nonobese nondiabetic patients (p < 0.001). The prevalence of sarcopenic obesity was 40%, 11%, and 30%, respectively (p < 0.001). Diabetes was associated with 2.3-fold greater odds (95% CI 1.1-4.7) of sarcopenia and 2.4-fold greater odds (1.1-5.0) of sarcopenic obesity after adjustment. A duration greater than 10 years, uncontrolled diabetes, age greater than 65 years, low physical activity, hypertension, and dyslipidemia also independently increased the odds.

CONCLUSION

Indian adults with type 2 diabetes have a high burden of sarcopenia and sarcopenic obesity. Early optimization of diabetes care and lifestyle changes are vital for preserving muscle health.

Type 2 diabetes mellitus related sarcopenia: a type of muscle loss distinct from sarcopenia and disuse muscle atrophy

Muscle loss is a significant health concern, particularly with the increasing trend of population aging, and sarcopenia has emerged as a common pathological process of muscle loss in the elderly. Currently, there has been significant progress in the research on sarcopenia, including in-depth analysis of the mechanisms underlying sarcopenia caused by aging and the development of corresponding diagnostic criteria, forming a relatively complete system. However, as research on sarcopenia progresses, the concept of secondary sarcopenia has also been proposed. Due to the incomplete understanding of muscle loss caused by chronic diseases, there are various limitations in epidemiological, basic, and clinical research. As a result, a comprehensive concept and diagnostic system have not yet been established, which greatly hinders the prevention and treatment of the disease. This review focuses on Type 2 Diabetes Mellitus (T2DM)-related sarcopenia, comparing its similarities and differences with sarcopenia and disuse muscle atrophy. The review show significant differences between the three muscle-related issues in terms of pathological changes, epidemiology and clinical manifestations, etiology, and preventive and therapeutic strategies. Unlike sarcopenia, T2DM-related sarcopenia is characterized by a reduction in type I fibers, and it differs from disuse muscle atrophy as well. The mechanism involving insulin resistance, inflammatory status, and oxidative stress remains unclear. Therefore, future research should further explore the etiology, disease progression, and prognosis of T2DM-related sarcopenia, and develop targeted diagnostic criteria and effective preventive and therapeutic strategies to better address the muscle-related issues faced by T2DM patients and improve their quality of life and overall health.

A review on associated factors and management measures for sarcopenia in type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease characterized by hyperglycemia, insulin resistance, and insufficient insulin secretion. Sarcopenia, as a new complication of diabetes, is characterized by the loss of muscle mass and the progressive decline of muscle strength and function in T2DM patients, which has a serious impact on the physical and mental health of patients. Insulin resistance, mitochondrial dysfunction, and chronic inflammation are common mechanisms of diabetes and sarcopenia. Reasonable exercise training, nutrition supplement, and drug intervention may improve the quality of life of patients with diabetes combined with sarcopenia. This article reviews the relevant factors and management measures of sarcopenia in T2DM patients, in order to achieve early detection, diagnosis, and intervention.

Research Progress on the Effect and Mechanism of Tea Products with Different Fermentation Degrees in Regulating Type 2 Diabetes Mellitus

A popular non-alcoholic beverage worldwide, tea can regulate blood glucose levels, lipid levels, and blood pressure, and may even prevent type 2 diabetes mellitus (T2DM). Different tea fermentation levels impact these effects. Tea products with different fermentation degrees containing different functional ingredients can lower post-meal blood glucose levels and may prevent T2DM. There are seven critical factors that shed light on how teas with different fermentation levels affect blood glucose regulation in humans. These factors include the inhibition of digestive enzymes, enhancement of cellular glucose uptake, suppression of gluconeogenesis-related enzymes, reduction in the formation of advanced glycation end products (AGEs), inhibition of dipeptidyl peptidase-4 (DPP-4) activity, modulation of gut flora, and the alleviation of inflammation associated with oxidative stress. Fermented teas can be used to lower post-meal blood glucose levels and can help consumers make more informed tea selections.

Decreased serum musclin concentration is independently associated with the high prevalence of sarcopenia in Chinese middle-elderly patients with type 2 diabetes mellitus

INTRODUCTION AND AIMS

Sarcopenia is a complication of diabetes mellitus, which can increase hospitalization and lead to poor outcomes. The present study investigated the relationship between the serum musclin concentration and the sarcopenia morbidity in Chinese middle-elderly patients with type 2 diabetes mellitus.

METHODS

We recruited 220 patients with type 2 diabetes mellitus, all of whom completed gait speed, handgrip strength tests, and whole-body dual-energy x-ray measurements to calculate the appendicular skeletal muscle mass index (ASMI). The patients were divided into sarcopenia (n = 110) and non-sarcopenia groups (n = 110). The serum musclin concentration was measured using an enzyme-linked immunosorbent assay.

RESULTS

The serum musclin concentration was significantly lower in the sarcopenia group (712.82 pg/mL) than in the non-sarcopenia group (922.53 pg/mL). The serum musclin concentration positively correlated with the whole-body skeletal mass (r = 0.230; P = 0.001). Sarcopenia morbidity declined as the quartile of serum musclin concentration increased (P = 0.001), and a negative correlation was observed between the serum musclin concentration and the prevalence of sarcopenia (odds ratio = 0.998, P = 0.001). The correlation remained when quartiles were considered.

CONCLUSIONS

The serum musclin concentration is an independent protective factor for sarcopenia in Chinese middle-elderly patients with type 2 diabetes mellitus.

Association of a Combination of Sarcopenia and Type 2 Diabetes with Blood Parameters, Nutrient Intake, and Physical Activity: A Nationwide Population-Based Study

This study aimed to investigate the association of sarcopenia and type 2 diabetes (T2D) with blood parameters, nutrient intake, and physical activity in older Korean adults. We divided 2952 participants into four groups: sarcopenic diabetes (SD), sarcopenia alone (S), diabetes alone (D), and non-sarcopenia and non-diabetes (NSND). Sarcopenia was defined by the appendicular skeletal muscle mass index, and T2D by fasting glucose levels or ongoing treatment. Blood samples were collected after an 8-h fast. Nutrient intake was assessed using a 24-h recall; physical activity was evaluated using a questionnaire. Compared with those in the other groups, the men in the S and SD groups showed significantly lower hemoglobin and hematocrit levels; vitamin D levels in men and parathyroid hormone levels in women were significantly lower in the SD group. Total energy, protein, and carbohydrate intakes were significantly lower in the SD and S groups than those in the D and NSND groups. Physical inactivity was significantly more common in the SD group (men: odds ratio, 1.61; women: odds ratio, 2.37) than in the NSND group. A combination of sarcopenia and diabetes as well as sarcopenia alone was associated with low levels of blood parameters, poor nutrient intake, and low physical activity.

Low Muscle Mass Is Associated with Poorer Glycemic Control and Higher Oxidative Stress in Older Patients with Type 2 Diabetes

Body composition changes that occur during aging, such as loss of lean mass, are unfavorable at metabolic level and they can explain, in part, the appearance of certain age-associated diseases such as type 2 diabetes (T2D). Separately, T2D is associated with an increase in oxidative stress (OS) which negatively affects skeletal muscle. Our aim was to study the differences in clinical and nutritional parameters, disease control, and OS in a cohort of older patients with T2D classified according to the amount of lean mass they had. We included 100 adults older than 65 years with T2D. We found that women with low fat-free mass and muscle mass have worse T2D metabolic control. Moreover, the patients with a low percentile of muscle mass present a high value of OS. The study shows that the presence of low lean mass (LM) in the geriatric population diagnosed with T2D is associated with poorer glycemic control and greater OS.

A new, alternative risk score for sarcopenia in Chinese patients with type 2 diabetes mellitus

OBJECTIVE

To develop a new, alternative sarcopenia risk score to screen for sarcopenia in type 2 diabetes patients in China and to demonstrate its validity.

RESEARCH DESIGN AND METHODS

The data for this study came from a multicenter, cross-sectional study that had been designed to estimate the prevalence of sarcopenia among adults with type 2 diabetes and had been conducted in several hospitals in Beijing, China. A total of 1125 participants were randomly divided into two groups: an exploratory population and a validation population. A multivariable logistic regression model using the backward stepwise likelihood ratio method to estimate the probability of sarcopenia was fitted with candidate variables in the exploratory population. A new, alternative sarcopenia risk score was developed based on the multivariable model. The internal and external validations were performed in the exploratory and validation populations. The study was registered at Chinese Clinical Trial Registry (ChiCTR-EOC-15006901).

RESULTS

The new, alternative sarcopenia risk score included five variables: age, gender, BMI, total energy intake per day, and the proportion of calories supplied by protein. The score ranged from - 2 to 19. The area under the receiver operating characteristic (ROC) curve of the risk score for the prediction of sarcopenia in type 2 diabetes patients was 0.806 (95% CI 0.741-0.872) and 0.836 (95% CI 0.781-0.892) in the exploratory and validation populations, respectively. At the optimal cutoff value of 12, the sensitivity and specificity of the score for the prediction of sarcopenia were 70.9% and 81.0% in the exploratory population and 53.7% and 88.8% in the validation population, respectively. The Hosmer-Lemeshow goodness-of-fit test showed a good calibration with the risk score in external validation (χ² = 4.459, P = 0.813).

CONCLUSIONS

The new, alternative sarcopenia risk score appears to be an effective screening tool for identification of sarcopenia in Chinese patients with type 2 diabetes in clinical practice. Clinical trial registration Chinese Clinical Trial Registry, ChiCTR-EOC-15006901.

Diet, exercise, and pharmacotherapy for sarcopenia in people with diabetes

Diabetes prevalence is increasing rapidly in older people, and sarcopenia is prevalent as a novel complication, particularly in patients with type 2 diabetes mellitus (T2DM). Therefore, sarcopenia prevention and treatment in these people is necessary. Diabetes accelerates sarcopenia through several mechanisms, such as hyperglycemia, chronic inflammation and oxidative stress. The effects of diet, exercise, and pharmacotherapy on sarcopenia in patients with T2DM need to be considered. In diet, low intake of energy, protein, vitamin D, and ω-3 fatty acid are associated with sarcopenia risk. In exercises, although intervention studies in people, especially older and non-obese patients with diabetes, are few, accumulating evidence shows the usefulness of exercise, particularly resistance exercise for muscle mass and strength, and aerobic exercise for physical performance in sarcopenia. In pharmacotherapy, certain classes of anti-diabetes compounds have possibility of preventing sarcopenia. However, much data on diet, exercise, and pharmacotherapy were obtained in obese and non-elderly patients with T2DM, demanding actual clinical data on non-obese and older patients with diabetes.

Higher Risk of Sarcopenia in Older Adults with Type 2 Diabetes: NHANES 1999-2018

INTRODUCTION

Recent studies suggested that sarcopenia may be a significant comorbidity of diabetes mellitus (DM). Nonetheless, studies with nationally representative data are scarce, and the changing trend of sarcopenia prevalence over time is largely unknown. Therefore, we aimed to estimate and compare the prevalence of sarcopenia in diabetic and nondiabetic US older population, and to explore the potential predictors of sarcopenia as well as the trend of sarcopenia prevalent in the past decades.

METHODS

Data were retrieved from the National Health and Nutrition Examination Survey (NHANES). Sarcopenia and DM were defined according to corresponding diagnosis criteria. Weighted prevalence was calculated and compared between diabetic and nondiabetic participants. The differences among age and ethnicity groups were explored.

RESULTS

A total of 6,381 US adults (>50 years) were involved. The overall prevalence of sarcopenia was 17.8% for US elders, and the prevalence was higher (27.9% vs. 15.7%) in those with diabetes ones than those without. Stepwise regression revealed that sarcopenia was significantly associated with DM (adjusted odds ratio = 1.37, 95% CI: 1.08-1.22; p < 0.05) after controlling for potential confounders including gender, age, ethnicity, educational level, BMI, and muscle strengthening activity. A slight fluctuation but overall increasing trend of sarcopenia prevalence was observed among diabetic elders, while no obvious changing trend was observed in their counterparts in recent decades.

CONCLUSION

Diabetic US older adults face significantly higher risk of sarcopenia when compared with their nondiabetic counterparts. Gender, age, ethnicity, educational level, and obesity were important influencing factors of sarcopenia development.

Use machine learning to help identify possible sarcopenia cases in maintenance hemodialysis patients

BACKGROUND

Maintenance hemodialysis (MHD) patients often suffer from sarcopenia, which is strongly associated with their long-term mortality. The diagnosis and treatment of sarcopenia, especially possible sarcopenia for MHD patients are of great importance. This study aims to use machine learning and medical data to develop two simple sarcopenia identification assistant tools for MHD patients and focuses on sex specificity.

METHODS

Data were retrospectively collected from patients undergoing MHD and included patients' basic information, body measurement results and laboratory findings. The 2019 consensus update by Asian working group for sarcopenia was used to assess whether a MHD patient had sarcopenia. Finally, 140 male (58 with possible sarcopenia or sarcopenia) and 102 female (65 with possible sarcopenia or sarcopenia) patients' data were collected. Participants were divided into sarcopenia and control groups for each sex to develop binary classifiers. After statistical analysis and feature selection, stratified shuffle split and Synthetic Minority Oversampling Technique were conducted and voting classifiers were developed.

RESULTS

After eliminating handgrip strength, 6-m walk, and skeletal muscle index, the best three features for sarcopenia identification of male patients are age, fasting blood glucose, and parathyroid hormone. Meanwhile, age, arm without vascular access, total bilirubin, and post-dialysis creatinine are the best four features for females. After abandoning models with overfitting or bad performance, voting classifiers achieved good sarcopenia classification performance for both sexes (For males: sensitivity: 77.50% ± 11.21%, specificity: 83.13% ± 9.70%, F1 score: 77.32% ± 5.36%, the area under the receiver operating characteristic curves (AUC): 87.40% ± 4.41%. For females: sensitivity: 76.15% ± 13.95%, specificity: 71.25% ± 15.86%, F1 score: 78.04% ± 8.85%, AUC: 77.69% ± 7.92%).

CONCLUSIONS

Two simple sex-specific sarcopenia identification tools for MHD patients were developed. They performed well on the case finding of sarcopenia, especially possible sarcopenia.

Metabolomics analysis reveals serum biomarkers in patients with diabetic sarcopenia

INTRODUCTION

Diabetic sarcopenia (DS) is characterized by muscle atrophy, slower nerve conduction, reduced maximum tension generated by skeletal muscle contraction, and slower contraction rate. Hence, DS can cause limb movement degeneration, slow movement, reduced balance, reduced metabolic rate, falls, fractures, etc. Moreover, the relevant early biological metabolites and their pathophysiological mechanism have yet to be characterized.

METHOD

The current cross-sectional study employed serum metabolomics analysis to screen potential noninvasive biomarkers in patients with diabetic sarcopenia. A total of 280 diabetic patients were enrolled in the study (n = 39 sarcopenia [DS], n = 241 without sarcopenia [DM]). Ten patients were randomly selected from both groups. Non-targeted metabolomic analysis was performed by ultra-high-performance liquid chromatography-electrospray ionization tandem mass spectrometry.

RESULTS

A total of 632 differential metabolites were identified, including 82 that were significantly differentially abundant (P < 0.05, VIP > 1, FC > 1.2 or FC < 0.8). Compared with the DM group, the contents of pentadecanoic acid, 5'-methylthioadenosine (5'-MTA), N,N-dimethylarginine (asymmetric dimethylarginine, ADMA), and glutamine in the DS group were significantly increased, while that of isoxanthohumol was decreased.

DISCUSSION

Based on receiver operating characteristic curve analysis, pentadecanoic acid, 5'-MTA, ADMA, and glutamine may serve as potential biomarkers of DS. Moreover, ATP-binding cassette (ABC) transporters and the mammalian target of the rapamycin signaling pathway were found to potentially have important regulatory roles in the occurrence and development of DS (P < 0.05). Collectively, the differential metabolites identified in this study provide new insights into the underlying pathophysiology of DS and serve as a basis for therapeutic interventions.

[Malnutrition management of hospitalized patients with diabetes/hyperglycemia and sarcopenia]

Introduction

Sarcopenia is a multidimensional condition that negatively affects muscle mass, muscle strength, and physical performance. The prevalence of sarcopenia in people with diabetes is much higher than that of the general population, especially in individuals with poor nutritional status. Both sarcopenia and malnutrition are conditions amenable to intervention to improve clinical prognosis. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with sarcopenia.

Focus on Nutritional Aspects of Sarcopenia in Diabetes: Current Evidence and Remarks for Future Research

Sarcopenia has been defined as a progressive and generalized loss of muscle mass that can be observed after the age of 40 years, with a rate of deterioration of about 8% every ten years up to 70 years, and 15-25% thereafter [...].

A Low Free T3 to Free T4 Ratio Is Associated with Sarcopenia in Euthyroid Patients with Type 2 Diabetes Mellitus

BACKGROUND

This research evaluated the link between normal thyroid hormone levels and sarcopenia in patients with type 2 diabetes mellitus (T2DM).

METHODS

This cross-sectional study enrolled 312 euthyroid patients with T2DM from Qilu Hospital of the Shandong University, China. Body composition, grip strength, and physical performance were assessed as per the 2019 consensus guidelines of the Asian Working Group for Sarcopenia. Binary logistic regression was used to examine the correlation between thyroid hormone levels and sarcopenia and its components.

RESULTS

The prevalence of sarcopenia was 26.9%. Following adjustments for potential confounders, a high-normal serum free triiodothyronine (FT3) level (odds ratio (OR) = 0.522, 95% confidence interval (CI): 0.304-0.895, P = 0.018), a low-normal serum free thyroxine (FT4) level (OR = 1.126, 95% CI: 1.009-1.258, P = 0.034), and a heightened FT3/FT4 ratio (OR = 0.923, 95% CI: 0.879-0.969, P = 0.001) were linked to a low prevalence of sarcopenia. Considering the components of sarcopenia, FT3 concentration was positively associated with muscle strength (OR = 0.525, 95% CI: 0.305-0.902, P = 0.020) and physical performance (OR = 0.443, 95% CI: 0.259-0.758, P = 0.003), while FT4 concentration was negatively linked to muscle mass (OR = 1.114, 95% CI: 1.009-1.232, P = 0.036). The FT3/FT4 ratio was positively linked to muscle mass (OR = 0.943, 95% CI: 0.905-0.981, P = 0.006), muscle strength (OR = 0.945, 95% CI: 0.901-0.992, P = 0.021), and physical performance (OR = 0.934, 95% CI: 0.894-0.975, P = 0.002). Nevertheless, thyroid-stimulating hormone concentration was not associated with sarcopenia.

CONCLUSION

A high FT3/FT4 ratio was significantly linked to a lowered risk of sarcopenia in euthyroid patients with T2DM.

The Relationship Between Fat-Free Mass and Glucose Metabolism in Children and Adolescents: A Systematic Review and Meta-Analysis

PURPOSE

To assess the relationship between fat-free mass (FFM) and glucose metabolism in children 0-18 years of age.

METHODS

We performed a systematic review of the literature on Medline/PubMed, SinoMed, Embase, and the Cochrane Library using the PRISMA 2020 guidelines to 12 October 2021; this encompassed observational studies in which the relationship between FFM and glucose metabolism was assessed. Correlation coefficient (r), regression coefficient (β), and odds ratio (OR) values in the studies were extracted and recorded as the primary data. "Agency for Healthcare Research and Quality" quality-assessment forms recommended for cross-sectional/prevalence studies were applied to evaluate the quality of the selected studies, and we executed R software to combine the pooled data.

RESULTS

We included eight studies comprising 13,282 individuals, five of which involved the assessment of the relationship between FFM and blood glucose, and four on the relationship between FFM and insulin resistance (IR). Our results showed that FFM was significantly associated with fasting plasma insulin levels (r = 0.34, 95% CI: 0.30-0.39, P < 0.001). Due to high heterogeneity or insufficient quantity of data, the studies of the relationship between FFM and fasting plasma glucose, HOMA-IR, or HbA1c were not congruent, and were therefore not suitable for meta-analysis.

CONCLUSION

Our results indicated that FFM was significantly associated with fasting plasma insulin levels. As far as we have determined, this is the first-ever systematic review and meta-analysis of the associations between FFM and glucose metabolism in children and adolescents; and our results thus provide novel information to fill a gap in the literature in this area.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020150320, PROSPERO CRD42020150320.

Anti-diabetic drugs and sarcopenia: emerging links, mechanistic insights, and clinical implications

Sarcopenia, characterized by loss of skeletal muscle mass, quality, and strength, has become a common hallmark of ageing and many chronic diseases. Diabetes mellitus patients have a higher prevalence of sarcopenia, which greatly aggravates the metabolic disturbance and compromises treatment response. Preclinical and clinical studies have shown differential impacts of anti-diabetic drugs on skeletal muscle mass, strength, and performance, highlighting the importance of rational therapeutic regimen from the perspective of sarcopenia risk. In this review, we provide an update on the regulation of muscle mass and quality by major anti-diabetic drugs, focusing primarily on emerging data from clinical studies. We also discuss the underlying mechanisms and clinical implications for optimal selection of anti-diabetic drugs to reduce the risk of sarcopenia. In view of the lifelong use of anti-diabetic drugs, we propose that a better understanding of the sarcopenia risk and interventional strategies is worthy of attention in future studies.

The prevalence and risk factors of sarcopenia in patients with type 2 diabetes mellitus: a systematic review and meta-analysis

BACKGROUND

Sarcopenia was a frequent chronic complication in patients with type 2 diabetes mellitus (T2DM), and previous evidence showed conflicting results regarding the prevalence and risk factors of sarcopenia in T2DM. In the current study, we aimed at systematically exploring the prevalence and risk factors of sarcopenia in patients with T2DM.

METHODS

PubMed, Embase, and Cochrane Central Register of Controlled Trials were systematically searched to identify observational studies which investigated the prevalence and risk factors of sarcopenia in patients with T2DM. The quality of individual included studies was evaluated using The Newcastle-Ottawa scale. Pooled effects regarding prevalence and associated factors were calculated using random-effects models. The potential publication bias was assessed via funnel plot and Egger test.

RESULTS

Twenty-eight studies involving 16,800 patients were included in our meta-analysis. The pooled prevalence of sarcopenia in patients with T2DM was 18% (95% CI 0.15-0.22; I² = 97.4%). The pooled results showed that elder age (OR 4.73; 95% CI 4.30-5.19; I² = 85.6%), male gender, chronic hyperglycemia (higher HbA1c) (OR 1.16; 95% CI 1.05-2.47; I² = 99.2%) and osteoporosis (OR 1.16; 95% CI 1.05-2.47; I² = 99.2%) was predictors for sarcopenia, whereas patients with lower BMI (OR 1.16; 95% CI 1.05-2.47; I² = 99.2%) and metformin administrations (OR 1.16; 95% CI 1.05-2.47; I² = 99.2%) were not prone to get sarcopenia. The funnel plot and statistical tests showed no obvious publication bias.

CONCLUSIONS

Sarcopenia was frequent in T2DM patients. Elder age, male gender and chronic hyperglycemia, Osteoporosis were significant risk factors for Sarcopenia. Lower BMI and metformin administrations were associated with lower risk of sarcopenia.