Accelerated Loss of Skeletal Muscle Strength in Older Adults With Type 2 Diabetes

Abstract

OBJECTIVE -It has been shown that adults with either long-standing type 1 or type 2 diabetes had lower skeletal muscle strength than nondiabetic adults in cross-sectional studies. The aim of the study was to investigate longitudinal changes of muscle mass and strength in community-dwelling older adults with and without type 2 diabetes.RESEARCH DESIGN AND METHODS -We examined leg and arm muscle mass and strength at baseline and 3 years later in 1,840 older adults aged 70 -79 years in the Health, Aging, and Body Composition Study. Regional muscle mass was measured by dual energy X-ray absorptiometry, and muscle strength was measured using isokinetic and isometric dynamometers.RESULTS -Older adults with type 2 diabetes (n ϭ 305) showed greater declines in the leg muscle mass (Ϫ0.29 Ϯ 0.03 vs. Ϫ0.23 Ϯ 0.01 kg, P Ͻ 0.05) and strength (Ϫ16.5 Ϯ 1.2 vs. Ϫ12.4 Ϯ 0.5 Nm, P ϭ 0.001) compared with older adults without diabetes. Leg muscle quality, expressed as maximal strength per unit of muscle mass (Newton meters per kilogram), also declined more rapidly in older adults with diabetes (Ϫ1.6 Ϯ 0.2 vs. Ϫ1.2 Ϯ 0.1 Nm/kg, P Ͻ 0.05). Changes in arm muscle strength and quality were not different between those with and without diabetes. Rapid declines in leg muscle strength and quality were attenuated but remained significant after controlling for demographics, body composition, physical activity, combined chronic diseases, interleukin-6, and tumor necrosis factor-␣.CONCLUSIONS -In older adults, type 2 diabetes is associated with accelerated loss of leg muscle strength and quality. Diabetes Care 30

Diabetes and Risk of Frailty and Its Potential Mechanisms: A Prospective Cohort Study of Older Adults

“…The Study of Osteoporotic Fractures (39) showed that diabetes was prospectively associated with declines in walking speed, but not in handgrip strength. This last finding is in accordance with the Health, Aging, and Body Composition Study (23), where, although type 2 diabetes was associated with an accelerated loss of leg muscle strength and quality, no association with arm muscle strength or quality was observed. Similarly, although in our study diabetes was associated with decreased walking speed, we observed no significant association between diabetes and hand-grip weakness.…”

“…Some studies have also shown that older diabetic individuals have an accelerated loss of skeletal muscle strength (23,24), which is more pronounced among those with poor glycemic control (HbA1c>8%) (25). Still, to our knowledge only one previous study has evaluated the role of hyperglycemia in frailty development.…”

“…In this regard, previous studies linking diabetes with reduced walking speed (39,(43)(44)(45) have attributed this association to the accelerated loss of skeletal muscle strength that is commonly seen in older adults with this metabolic disease (23,24). To address whether diabetes-related muscle impairments could mediate the association between diabetes and low walking speed, researchers from the InCHIANTI study assessed walking performance and lower-extremity muscle mass, strength and power in a sample of 835 older adults (43).…”

Effect of exercise training on neuromuscular function of elbow flexors and knee extensors of type 2 diabetic patients

“…Reduced muscle strength of the knee extensors muscles in T2D patients, has been 13 reported during maximal isokinetic (Andersen et al 1996;Park et al 2007;Kalyani et 14 al. 2013) and isometric tasks (Ijzerman et al 2012) while a comparable isokinetic 15 strength with respect to healthy controls has been found in muscles acting around the 16 elbow (Andersen et al 2004) and the wrist (Andreassen et al 2006;Park et al 2007).…”

Frailty – An emerging high impact complication of diabetes requiring specific management approaches

“…Muscle loss is also accelerated in diabetes (13) and lower limb muscles may be in a profound state of insulin resistance (14). As a consequence, the clinician must now also consider the use of insulin sensitisers combined with weight loss and resistance exercise to improve muscle function in frailty (7).…”