Applications of physical performance measures to routine diabetes care for frailty prevention concept: fundamental data with grip strength, gait speed, timed chair stand speed, standing balance, and knee extension strength

Yokoyama, Hiroyuki; Shiraiwa, Toshihiko; Takahara, Mitsuyoshi; Iwamoto, Masahiro; Kuribayashi, Nobuichi; Nomura, Takuo; Yamada, Minoru; Sone, Hirohito; Araki, Shin‐ichi

doi:10.1136/bmjdrc-2020-001562

Cited by 10 publications

(5 citation statements)

References 47 publications

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“…Our results are concordant with those of Neri et al 40 who found that adiposity measures, in particular waist circumference, were associated with postural instability and higher risk of falls in older adults. In addition, the higher percentage of participants with diabetes mellitus in the NO 10-s OLS group suggests that some of these participants have subclinical central or autonomic nervous system dysfunction, as has been recently reported 41…”

Section: Discussionsupporting

confidence: 51%

Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals

Araújo¹,

Silva²,

Laukkanen

et al. 2022

Br J Sports Med

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ObjectivesBalance quickly diminishes after the mid-50s increasing the risk for falls and other adverse health outcomes. Our aim was to assess whether the ability to complete a 10- s one-legged stance (10-second OLS) is associated with all-cause mortality and whether it adds relevant prognostic information beyond ordinary demographic, anthropometric and clinical data.MethodsAnthropometric, clinical and vital status and 10-s OLS data were assessed in 1702 individuals (68% men) aged 51–75 years between 2008 and 2020. Log-rank and Cox modelling were used to compare survival curves and risk of death according to ability (YES) or inability (NO) to complete the 10-s OLS test.ResultsOverall, 20.4% of the individuals were classified as NO. During a median follow-up of 7 years, 7.2% died, with 4.6% (YES) and 17.5% (NO) on the 10-s OLS. Survival curves were worse for NO 10-s OLS (log-rank test=85.6; p<0.001). In an adjusted model incorporating age, sex, body mass index and comorbidities, the HR of all-cause mortality was higher (1.84 (95% CI: 1.23 to 2.78) (p<0.001)) for NO individuals. Adding 10-s OLS to a model containing established risk factors was associated with significantly improved mortality risk prediction as measured by differences in −2 log likelihood and integrated discrimination improvement.ConclusionsWithin the limitations of uncontrolled variables such as recent history of falls and physical activity, the ability to successfully complete the 10-s OLS is independently associated with all-cause mortality and adds relevant prognostic information beyond age, sex and several other anthropometric and clinical variables. There is potential benefit to including the 10-s OLS as part of routine physical examination in middle-aged and older adults.

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Section: Discussionsupporting

confidence: 51%

Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals

Araújo¹,

Silva²,

Laukkanen

et al. 2022

Br J Sports Med

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“…Gait speed and handgrip strength are robust predictors of adverse health events in older patients [36,37]. Previous evidence suggests that physical performance measures are impaired in diabetic patients [38]. Lower grip strength was associated with poor glycemic control in patients with diabetes mellitus (OR: 0.67; 95% CI: 0.47, 0.97) [39].…”

Section: Discussionmentioning

confidence: 95%

Frailty and risk of microvascular complications in patients with type 2 diabetes: a population-based cohort study

Xiong

Tan

et al. 2022

BMC Med

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Background Cross-sectional studies found that frailty was associated with prevalent diabetic microvascular complications (DMC). Longitudinal evidence in this regard is inconclusive and insufficient. We aimed to prospectively evaluate the association of pre-frailty and frailty with DMC in patients with type 2 diabetes (T2D). Methods We included 18,062 adults (mean age 59.4 ± 7.2 years, 37.4% female) with T2D at baseline in the UK Biobank. Frailty was defined using the frailty phenotype according to five components (weight loss, exhaustion, low physical activity, slow gait speed, and low grip strength). DMC, defined as diabetic nephropathy, diabetic neuropathy, or diabetic retinopathy, was identified using hospital inpatient records and death registries. Cox proportional hazard regression models considering competing risks were used to evaluate the associations of frailty phenotype with overall DMC events and subtypes. Results Among all participants, 6101 (33.8%) were classified as non-frail, 10,073 (55.8%) were classified as pre-frail, and 1888 (10.4%) were classified as frail. During a median follow-up of 12.0 years, 3678 DMC cases were documented, including 2213 diabetic nephropathy, 1520 diabetic retinopathy, and 673 diabetic neuropathy events. In the multivariable-adjusted model, compared with participants with non-frail, both pre-frailty and frailty were significantly associated with increased risk of overall DMC (HR 1.10, 95% CI: [1.02, 1.18] for pre-frailty and HR 1.52 [95% CI: 1.36, 1.69] for frailty). Similar results were observed in the subtypes of DMC. For each one-point increase in frailty phenotype score, the risk of overall DMC, diabetic nephropathy, diabetic retinopathy, and diabetic neuropathy event increased by 13%, 16%, 10%, and 20%, respectively. Conclusions Both pre-frailty and frailty were associated with an increased risk of DMC in patients with T2D. These findings have important implications for integrating early assessment and surveillance of frailty in diabetes and may favor the identification of at-risk patients.

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“…We believe that the addition of a lower body strength test to the HGS test is imperative since the HGS is a poor predictor of both total body strength [ 20 ], and functional performance [ 46 , 47 ], while yielding dissimilar sarcopenia rates compared to lower body testing (chair stands), in a community-dwelling group of middle aged and older adults [ 48 ]. The KES test can be recommended as an alternative lower body strength test for the chair rise test, as it involves less complex weight-bearing body movements [ 49 ], is better suited for diabetics with peripheral neuropathy [ 50 ], as well as obese older adults with moderate to advanced osteoarthritis [ 51 , 52 ].…”

Section: Discussionmentioning

confidence: 99%

Should knee extension strength testing be implemented as a screening test for identifying probable and confirmed sarcopenia in older T2DM patients?

Kis

Buch

Eldor

et al. 2022

Eur Rev Aging Phys Act

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Background The accelerated loss of muscle strength and mass observed in older type 2 diabetes mellitus (T2DM) patients due to the combined effects of diabetes and obesity, greatly increases their risk for sarcopenia. Early detection and treatment of probable and confirmed sarcopenia is paramount to delay mobility disability. Using low handgrip strength cut-off points for the initial identification of sarcopenia according to the new European Working Group on Sarcopenia in Older People (EWGSOP2) guidelines may mask the presence of sarcopenia. Relative knee extension strength cut-off points using a simple hand-held dynamometer can assist clinicians in the diagnosis of probable and confirmed sarcopenia by possibly reducing false negative results. Methods A cohort of one hundred T2DM older patients (60% women) (mean age 74.5 years) mostly obese community dwelling older adults were evaluated for body composition by Bioelectrical impedance analysis (BIA), yielding appendicular skeletal mass index (ASMI) results. Patients underwent handgrip strength (HGS) and knee extension strength (KES) tests as well as functional ability tests. Prevalence of probable and confirmed sarcopenia using HGS and KES cut-off points were calculated. Pearson correlations were performed to evaluate the relationship between ASMI and limbs strength. A regression analysis was conducted to examine which variables best predict ASMI values. A multivariate analysis of covariance was performed to assess the effect of independent variables on KES and HGS. Results Using cutoff points for low KES identified 24 patients with probable sarcopenia and two with confirmed sarcopenia. Conversely, using the EWGSOP2 cut off points for low HGS, identified only one patient with probable sarcopenia and none of the patients with confirmed sarcopenia. Conclusion KES cut-off points using a simple hand-held dynamometer can assist in the identification of probable and confirmed sarcopenia using EWGSOP2 cut off points for low muscle mass in a population of older T2DM patients for further analysis and early treatment. This is notably true in patients possessing high body mass index (BMI) alongside normal ASMI and HGS, potentially reducing false positive sarcopenia screening results. Trial registration ClinicalTrials.gov PRS: NCT03560375. Last registration date (last update): 06/06/2018. The trial was a-priori registered before actual recruitment of subjects.

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Applications of physical performance measures to routine diabetes care for frailty prevention concept: fundamental data with grip strength, gait speed, timed chair stand speed, standing balance, and knee extension strength

Cited by 10 publications

References 47 publications

Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals

Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals

Frailty and risk of microvascular complications in patients with type 2 diabetes: a population-based cohort study

Should knee extension strength testing be implemented as a screening test for identifying probable and confirmed sarcopenia in older T2DM patients?

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