Role of handgrip strength in predicting new-onset diabetes: findings from the survey of health, ageing and retirement in Europe

Hand grip strength as a proposed new vital sign of health: a narrative review of evidences

Hand grip strength (HGS) serves as a fundamental metric in assessing muscle function and overall physical capability and is particularly relevant to the ageing population. HGS holds an important connection to the concept of sarcopenia, which encompasses the age-related decline in muscle mass, strength, and function. It has also been reported to indicate the health of an individual. We reviewed the interplay between HGS and various health parameters, including morbidity and mortality, by carrying out a literature search on PubMed, Scopus and Google Scholar between 10 and 30 August 2023, to identify the relevant papers on the relationship between health and HGS. We used several keywords like 'hand grip strength', 'muscle strength, 'sarcopenia', 'osteosarcopenia', 'health biomarker', 'osteoporosis', and 'frailty', to derive the appropriate literature for this review. This review has shown that the HGS can be measured reliably with a hand-held dynamometer. The cut-off values are different in various populations. It is lower in Asians, women, less educated and privileged, and those involved in sedentary work. Several diseases have shown a correlation with low HGS, e.g., Type 2 diabetes, cardiovascular disease, stroke, chronic kidney and liver disease, some cancers, sarcopenia and fragility fractures. The low HSG is also associated with increased hospitalization, nutritional status, overall mortality and quality of life. We believe that there is adequate evidence to show that HGS stands as an important biomarker of health. Its utility extends to the identification of diverse health issues and its potential as a new vital sign throughout the lifespan.

One-Year Handgrip Strength Change in Kindergarteners Depends upon Physical Activity Status

Free play in kindergarten can be roughly divided into fine and gross motor activities, but the effects of these activities on improving handgrip strength are unknown. Therefore, we aimed to compare one-year changes in handgrip strength and forearm flexor muscle size in children separated by preferred play in a kindergarten. One hundred and eleven children were recruited from a local kindergarten. They underwent handgrip strength and forearm muscle thickness measurements, and 95 (49 boys and 46 girls) underwent a second measurement one year after the first measurement. Class teachers assessed the physical activity of everyone in their class after the second measurement. Using three evaluation scores by the class teachers, we divided children into three groups based on the children's preference to play in kindergarten (fine movement vs. gross motor movement). Handgrip strength did not change differently between groups across one year. However, children who liked active playing outside (i.e., gross motor activity) were stronger than others. Furthermore, children who like playing outside observed greater changes than the other groups in the ulna (right hand) and radius muscle thickness (left hand), suggesting that changes in forearm muscle size might be incongruent with changes in handgrip strength among the three activity groups.

Hand grip strength is inversely associated with total daily insulin dose requirement in patients with type 2 diabetes mellitus: a cross-sectional study

Background

Short-term (2 weeks to 3 months) insulin intensive therapy using continuous subcutaneous insulin infusion (CSII) can improve islet beta cell function and prolong glycemic remission in patients with newly diagnosed type 2 diabetes mellitus (T2DM). However, the total daily insulin dose (TDD, IU/kg/d) required to achieve near-normoglycemic control with CSII still needs to be frequently adjusted based on blood glucose monitoring. Although real-time continuous glucose monitoring (rtCGM), which measures the interstitial fluid glucose concentration continuously without much difficulty, facilitates the adjustment of insulin dosage, its adoption in the T2DM population is strictly limited by insurance coverage and lack of awareness of rtCGM among clinicians. Thus, it is of clinical significance to identify easy-to-use parameters that may allow a more rapid and accurate prediction of TDD requirement. This study aimed to explore the association between hand grip strength (HGS) and TDD requirement in patients with T2DM receiving CSII therapy.

Methods

A total of 180 eligible patients with T2DM were enrolled in the study and divided into three groups based on their HGS: low (L), medium (M), and high (H). The TDD requirement was calculated on day 7 or 8 of CSII treatment. Anthropometric parameters, including HGS, skeletal muscle mass, skeletal muscle index (SMI) and 6-m gait speed, and laboratory data, were collected on the morning of the second day after admission, within the first 24 h of CSII therapy. These parameters were used to identify significant predictors of TDD requirement using Pearson or Spearman correlation test, and stepwise multiple regression analysis.

Results

There were no significant differences in age, duration of T2DM, waist-to-hip ratio (WHR), body mass index (BMI), blood pressure, liver function, estimated glomerular filtration rate, triglyceride, total cholesterol, glycosylated hemoglobin A1c (HbA1c), homeostatic model assessment of insulin resistance (HOMA-IR), and homeostasis model assessment of beta cell function (HOMA-β) among the groups. The H group had higher body muscle mass-to-fat ratio (BMFR), skeletal muscle mass-to-fat ratio (SMFR), SMI, 6-m gait speed, and lower TDD requirement than the M and L groups. The HGS negatively correlated with TDD requirement (r = -0.33, p < 0.001) after adjusting for sex, age, BMI, WHR, HbA1c, Ln (HOMA-β), Ln (HOMA-IR), Ln (BMFR), Ln (SMFR), SMI, and 6-m gait speed. Multivariate stepwise regression analysis indicated that HGS was an independent predictor of TDD requirement in patients with T2DM (β = -0.45, p < 0 001).

Conclusion

Lower HGS is associated with an increased TDD requirement in T2DM patients. HGS may facilitate the prediction of TDD requirement in T2DM patients receiving CSII therapy.

Lower body muscle strength, dynapenic obesity and risk of type 2 diabetes -longitudinal results on the chair-stand test from the Survey of Health, Ageing and Retirement in Europe (SHARE)

BACKGROUND

The chair-stand test is a measure of lower body muscle strength. In a longitudinal study with older adults, we investigated whether results of the five-repetition chair-stand test (CST-5) are associated with incident type 2 diabetes, and whether diabetes risk in obese persons is modified by dynapenia (age-related loss of muscle strength) in the lower limbs.

METHODS

We used data of the Survey of Health, Ageing and Retirement in Europe (SHARE), a panel study with eight waves carried out between 2004 and 2020 in 28 European countries and Israel mainly in persons aged 50 years or older. Forty-six thousand one hundred nineteen persons (mean age 63.5 years, 44.1% men) with CST-5 data and follow-up data for diabetes were included from wave 2 and waves 4 to 7. The mean follow-up time was 5.3 years (standard deviation 2.9 years). Relative risks with 95% confidence intervals (CI) were estimated from log-linear models with a Poisson working likelihood and robust standard errors.

RESULTS

In the crude model, increased risks of diabetes were found for persons who considered the CST-5 as not safe, or whose times for the test were in the highest or second highest quartiles (relative risks 2.18 (95% CI: 1.95-2.43), 1.71 (1.54-1.91), 1.44 (95% CI: 1.29-1.61), reference: lowest quartile). These associations were attenuated in the fully adjusted regression model (relative risks 1.32 (95% CI: 1.17-1.48), 1.23 (1.10-1.37), 1.19 (1.06-1.33)). Furthermore, in fully adjusted models, the risk of diabetes in obese persons did not depend on whether they had low muscle strength or not. In obese persons with times for 5 sits and stands > 15 seconds, the adjusted risk of diabetes was 2.56 (95% CI: 2.22-2.95) times higher than in non-obese persons with times ≤15 seconds. The corresponding relative risk in obese persons with times ≤15 seconds was 2.45 (2.25-2.67).

CONCLUSIONS

Poor results in the CST-5 were associated with an increased risk of diabetes. Among obese persons, the risk of diabetes was not modified by results of the CST-5.

Low relative hand grip strength is associated with a higher risk for diabetes and impaired fasting glucose among the Korean population

OBJECTIVE

This study investigated the association between relative hand grip strength (HGS) and glycemic status, such as impaired fasting glucose (IFG) and diabetes, using data from the Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

We performed a cross-sectional study using the data from the KNHANES of 27,894 individuals from 2014 to 2019. Relative HGS was defined as the absolute HGS divided by body mass index and divided into quartiles in men and women. Odds ratios (OR) for diabetes and IFG were calculated using multivariate logistic regression analysis. All analyses were stratified by sex, and subgroup analysis was age-stratified.

RESULTS

The lowest relative HGS quartile had a significant increase in the risk for diabetes (men: OR 2.72, 95% confidence interval [CI] 2.12-3.50; women: OR 3.38, 95% CI 2.70-4.24) and IFG (men: OR 1.35, 95% CI 1.15-1.59; women: OR 1.60, 95% CI 1.40-1.84). The ORs for diabetes and IFG according to the decreasing quartiles of relative HGS gradually increased in both sexes (P for trend <0.001). ORs and 95% CI of the lowest relative HGS quartile for diabetes were higher in the younger age group than that of the older age group (men: 4.47 and 2.80-7.14 for young adults; 2.41 and 1.37-4.25 for older adults; women: 5.91 and 3.06-9.38 for young adults; 1.47 and 0.92-2.33 for older adults). ORs and 95% CI for IFG was similar with the trend of ORs for diabetes (men: 1.80 and 1.43-2.26 for young adults; 1.17 and 0.75-1.84 for older adults; women: 2.20 and 1.77-2.72 for young adults; 1.33 and 0.86-2.07 for older adults).

CONCLUSION

Lower relative HGS was associated with a higher risk of not only diabetes but also IFG in both sexes. These trends were stronger in younger adults than in older adults.

Folic Acid Is Related to Muscle Strength and Vitamin A Is Related to Health-Related Quality of Life: Results of the Korea National Health and Nutrition Examination Survey (KNHANES VII 2016-2018)

This study investigated how folic acid affects muscle strength and the effects of vitamin A on quality of life in adults. Baseline data from the Korea National Health and Nutrition Examination Survey (KNHANES VII 2016–2018) was used to find 6112 adults (ages 19–80) meeting study criteria. The participants were divided into three groups: young adults (ages 19–39), middle-aged (ages 40–64), and elderly (≥65 years). Muscle strength was measured using a digital grip strength dynamometer. The EuroQol five-dimension questionnaire measured quality of life. Associations were assessed using multivariate regression and logistic regression. Vitamins and handgrip strength were divided into low and high groups based on the mean. Although vitamin A and folate levels were related to handgrip strength in all subjects, regression demonstrated a significant association between folate and handgrip strength in the elderly. The odds ratios (OR) of higher handgrip strength were statistically significant for elderly participants with high levels of folate compared to those with low levels (OR: 1.55). Vitamin A was associated with quality of life, especially in the self-care dimension for the elderly. Further longitudinal research is needed to examine the relationship between vitamins and muscle strength, as well as vitamins and quality of life.