Prevalence of sarcopenia and its determinants in people with type 2 diabetes: Experience from a tertiary care hospital in north India

OBJECTIVES

Changes in skeletal muscle mass and quality are associated with type 2 Diabetes (T2D) and its complications. We evaluated the prevalence of sarcopenia in patients with T2D and its association with various anthropometric and metabolic parameters.

METHODS

A total of 229 patients with T2D, ≥20-60 years, were screened for sarcopenia using handgrip strength (HGS) by dynamometer, physical performance test (by Short Physical and chair stand test), and height-adjusted appendicular skeletal muscle index (ASMI) by Dual Energy X-ray Absorptiometry (DXA) applying Asian Working Group on Sarcopenia (AWGS). Multiple logistic regressions were performed to identify the factors associated with sarcopenia.

RESULTS

The mean age was 46.2 ± 7.4 years with 55% being women. The prevalence of low HGS, poor physical performance, low ASMI, possible sarcopenia, sarcopenia, and severe sarcopenia was 16.2%, 39.3%, 33%, 43%, 18.8%, and 6.1%, respectively. Age >45 years and use of >2 oral hypoglycaemic agents (OHA's) were risk factors for low HGS (OR:3.51, 95%CI = 1.5-8.3) and low ASMI (OR:2.40, 95%CI = 1.05, 5.49, p-0.04), respectively. Female sex (OR:3.3 1.8-6.1 p < 0.01), age >45 years (OR:2.12, 95% CI = 1.2-3.8 p-0.012) and liver fibrosis (OR: 2.12, 95% CI = 1.01-4.46 p-0.048) were independently associated with poor performance. No association was found with HbA1c, dyslipidaemia, albuminuria, hypertension, or duration of diabetes and sarcopenia.

CONCLUSION

Sarcopenia is becoming increasingly recognized as a significant complication in younger individuals with T2D, and poor physical performance plays a vital role in its development. The prevalence of sarcopenia rises with advancing age, underscoring the importance of early intervention to address this condition.

Screening for diabetes in India should be initiated at 25 years age

BACKGROUND

Current guidelines state that screening for diabetes should be done at 30 years of age in India.

METHODS

Investigators from multiple sites in India were involved in providing data regarding patients with type 2 diabetes (T2D) aged 30 years or less. Other relevant studies were also reviewed.

RESULTS

Overview of published and unpublished data show increasing prevalence of T2D in individuals 30 years and less. About 3/4^th of them had overweight/obesity.

CONCLUSION

Screening for diabetes in India should start at 25 years in non-pregnant adults instead of 30 years as currently stipulated.

Exocrine pancreatic insufficiency related fat malabsorption and its association with autonomic neuropathy in Asian Indians with type 2 diabetes mellitus

BACKGROUND AND AIMS

We aimed to estimate the prevalence of exocrine pancreatic insufficiency (EPI) related fat malabsorption & to correlate it with measures of autonomic neuropathy in patients with T2DM from India.

METHODS

Patients with T2DM (cases; n = 118) and normo-glycaemic individuals (controls; n = 82) underwent anthropometry and biochemical evaluation at baseline. The 72-hours fecal fat excretion was estimated by the Van de Kamer's titration method. Autonomic neuropathy was evaluated using an automated analyzer.

RESULTS

The prevalence of EPI related fat malabsorption in cases was 45% (n = 53; 72 hours mean fecal fat level = 22.7 ± 5.6 g/day). Dysfunctions in the parasympathetic nervous system (PNS; 86.7%; p < 0.05), sympathetic nervous system (SNS; 92.4%; p < 0.05), and both; PNS + SNS (83.1%; p < 0.05) were significant. Amongst measures of PNS dysfunction, there was a significantly higher percentage of abnormal expiration: inspiration ratio (45.3%) and the 30:15 ratio (84.9%) (p < 0.05) in patients with T2DM and EPI related fat malabsorption.

CONCLUSION

In this cross-sectional cohort of Asian Indian patients with T2DM (n = 118), EPI related fat malabsorption correlates significantly with autonomic dysfunction in patients with T2DM. However, these preliminary data need to confirmed in trials with more robust design.

Magnitude of psychiatric comorbidity in patients with obesity in Northern Indian population

BACKGROUND AND AIMS

To determine the prevalence of different psychiatric comorbidities in patients with obesity and study their relationship with the degrees of obesity.

METHODS

This cross-sectional study included 151 patients with a BMI≥25 kg/m². Subjects with diagnosed psychiatric illness, type 2 diabetes mellitus, coronary artery disease or any neurological illness were excluded. Prevalence of psychiatric comorbidities was assessed by MINI screening tool for all major axis 1 disorders including anxiety, eating and mood disorders. The WHOQOL-BREF was used for assessment of well-being, in the four domains, physical, psychological, social and environmental.

RESULTS

Females constituted 68.6% of the study population. Lifetime diagnosis of any psychiatric illness was present in 24%, higher in females than males [31% vs 9%, p = 0.003]. The WHOQOL-BREF average scores of psychological, physical and environmental domains were significantly lower (p < 0.001) in patients diagnosed with depression as compared to those without. The WHOQOL-BREF average score of only the physical domain were significantly lower in individuals with BMI ≥30 kg/m² as compared to those with BMI <30 kg/m².

CONCLUSIONS

The burden of undiagnosed psychiatric comorbidity in patients with obesity decreases the quality of life. There is need to screen for psychiatric comorbidities for effective management of obesity.

Profile and prognosis of patients hospitalized for COVID-19 virus infection with and without diabetes - An observational study from South India

BACKGROUND AND AIMS

We studied the profile and outcome of patients hospitalized for coronavirus disease-19 (COVID-19) infection with and without type 2 diabetes (T2DM).

METHODS

In this observational study, clinical details of patients with COVID-19, identified by Reverse Transcription - Polymerase Chain Reaction admitted to 4 hospitals in Chennai, Tamil Nadu, India were collected from May to November 2020. A total of 845 (n = 423 with diabetes, n = 422 without diabetes) were selected for the analysis. Clinical details, biochemical and radiological investigations, diabetes treatment, intensive care, mortality and other adverse outcomes were recorded. Patients with clinical history of T2DM, glycosylated haemoglobin (HbA1c) of ≥6.5% (48 mmol/mol) and/or random blood glucose ≥200 mg/dl (11.1 mmol/l) were included. Statistical analyses were done using chi-square or 't' test and multiple logistic regression analysis.

RESULTS

At admission, patients with T2DM were older (p < 0.0001), had higher co-morbidities such as coronary artery disease (p = 0.02), hypertension (p < 0.0001), hypothyroidism (p = 0.03) and renal disorders (p = 0.01) than non-diabetes persons. Requirement for intensive care was higher among them. Acute renal injury or failure, pneumonia and myocardial infarction developed in higher percentage of T2DM. Mortality was significantly higher in T2DM (10.2% vs 5.9%, p = 0.02). However, in the multiple logistic regression analysis, only age (p < 0.0001) and renal disorders (p = 0.002) were significantly associated with mortality.

CONCLUSION

Our study showed that mortality was associated with higher age and renal disorders but did not show an association with diabetes, among patients hospitalized for COVID-19 infection.

About 1/3rd of north Indian patients less than 50 years of age with type 2 diabetes have high pulse wave velocity indicating high risk of atherosclerosis

BACKGROUND AND AIMS

Asian Indian patients with type 2 diabetes mellitus (T2DM) have a high cardiovascular risk even at young age. There is a need to assess this increased risk and identify atherosclerosis early so that appropriate measures for risk reduction can be taken. We aimed to study carotid-femoral pulse wave velocity (Cf-PWV), a non-invasive indicator of atherosclerosis, in patients with diabetes below 50 years of age and its correlation with markers of obesity and other cardiovascular risk factors.

METHODS

Patients (n, 299) with T2DM below 50 years of age underwent measurement of Cf-PWV by applanation tonometry. Anthropometric parameters, blood pressure, liver span, glycosylated hemoglobin, serum lipid profile, urinary microalbumin, ankle brachial index and carotid intima media thickness were measured.

RESULTS

Data show that 32.4% of patients had high Cf-PWV, with mean values higher in males than females. On stepwise multiple linear regression analysis, the significant independent determinants of PWV were age, systolic blood pressure, waist circumference, microalbumin and liver span.

CONCLUSION

About one third patients with T2DM less than 50 years of age, in north India have increased arterial stiffness which correlates with blood pressure, abdominal obesity, liver size and microalbumin, indicating increased risk for coronary artery disease.

Outcomes of metabolic surgery in obese patients with type 2 diabetes with respect to impact on beta cell function, insulin sensitivity and diabetes remission - A study from south India

BACKGROUND AND AIMS

Metabolic surgery is gaining popularity as a procedure for the treatment of morbid obesity among patients with type 2 diabetes (T2DM). The aim of the study was to evaluate the effects of metabolic surgery on beta cell function, insulin sensitivity and glycemic status in obese Asian Indian patients.

METHODS

This is a prospective study of 26 patients with T2DM who underwent metabolic surgery. Complete diabetes remission was defined as FPG<100 mg/dl and HbA1c < 6%, without antidiabetic medications one-year post surgery. Anthropometry, HOMA-IR (insulin resistance), HOMA-insulin sensitivity, beta cell function and antidiabetic drug usage were measured at baseline, 6 months and 12 months post-surgery.

RESULTS

The overall duration of diabetes was 10.3 ± 5.4 years. At one year, 7 (27%) of 26 T2DM patients, achieved diabetes remission while the other 19 had improvement in diabetes status. ROC curves showed that those who had diabetes duration <8.5 years achieved remission. There was a significant decrease in HOMA-IR [3.7 ± 1.8 vs 1.4 ± 0.9 vs1.2 ± 0.6, p < 0.001] and improvement in HOMA-Insulin sensitivity [34 ± 17 vs 93 ± 50 vs 112 ± 62, p < 0.001] from baseline to 6 and 12 months post-surgery respectively. There was a significant (p < 0.001) reduction in the usage of anti-diabetes medications post-surgery. The limitations of this study are small sample size and limited follow up period of 1 year.

CONCLUSIONS

Among T2DM patients, metabolic surgery resulted in significant improvement in beta cell function and insulin sensitivity along with reduction in anti-diabetes medication. Diabetes remission was mainly seen in those who had duration of diabetes <8.5 years.

Bioimpedance analysis with a novel predictive equation - A reliable technique to estimate fat free mass in birth weight based cohorts of Asian Indian males

AIM

To validate bioimpedance based predictive equations for fat free mass (FFM) against DEXA and to derive a novel birth weight based predictive equation for FFM in a birth weight based cohort of healthy Asian Indian men.

METHODOLOGY

Whole body composition was done using DEXA and bioimpedance in 117 young Asian Indian men, born of normal birth weight (n = 59, birth weight ≥2.5 kg) or low birth weight (n = 58, birth weight < 2.5 kg). Predictive accuracy of 11 different bioimpedance based equations for FFM was evaluated using Pearson's correlation analysis and the root of mean squared prediction error (RMSE) analysis.

RESULTS

The mean FFM (on DEXA) and total lean mass & impedance index (on bioimpedance) were significantly higher in the low birth weight cohort. Significantly higher body fat percentage was noted on bioimpedance, for the normal birth weight cohort, but not on DEXA. In addition, the mean values of predicted FFM were significantly higher in the low birth weight cohort for 9 different predictive equations. Specifically, the mean FFM values obtained using the predictive equations of Schaefer et al., Hoot cooper et al. and Hughes et al. were in close agreement with the actual FFM values on DEXA. A novel predictive equation (CMC equation) for FFM based on birth weight was derived. FFM = 32.637 + (-0.222*age) + (-32.51*waist-to-hip ratio) + (0.33*body mass index) + (1.58 * 1 or 2 (1 = normal birth weight, 2 = low birth weight) + (0.510*waist circumference).

CONCLUSIONS

Our study findings substantiate the validity of Bio-impedance analysis (BIA) as a reliable and noninvasive tool for estimating body composition measures in birth-weight based cohorts of Asian Indian males. Further, we have devised a novel BIA-based predictive equation that can be useful in larger epidemiological studies to look at alterations in body fat in this cohort.