Diabetes, sarcopenia and chronic kidney disease; the Screening for CKD among Older People across Europe (SCOPE) study

Abstract

Background Sarcopenia may be more present in older adults with diabetes (DM). Accordingly, we evaluated the prevalence of sarcopenia and its associated risk factors among community-dwelling older adults with DM. Methods A cross-sectional analysis of older people living in the community was carried out. Participants (aged 75 years and more) came from an European multicenter prospective cohort (SCOPE study). Global geriatric assessment including short physical performance battery, handgrip strength test and bioelectrical impedance analysis was performed. Sarcopenia was defined by the updated criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). Estimated glomerular filtration rate (eGFR) was calculated using Berlin Initiative Study (BIS) to define the stages of chronic kidney disease (CKD). Previous known DM was defined as physician-diagnosed DM registered in the patient's medical record or the use of DM-related medications. Hemoglobin A1c levels and specific DM therapies administered were collected. Time elapsed from the first diagnosis of DM was not collected and, therefore, was not included in the analyses. Results A total of 1,420 subjects were evaluated with a median age of 79.0 (6.0) years, of which 804 (56.6%) were women and 615 (43.3%) men; 315 (22.2%) participants had prior DM diagnosis, with a median age of 80.0 (6.0), 146 (46.3%) were women. Using EWGSOP2 definition, 150 (10.6%) participants in the SCOPE study met diagnostic criteria for sarcopenia. Participants without diabetes had more often normal results in the 3 sarcopenia components than participants with diabetes [887 (80.31%) vs. 227 (72.1%), p = 0.002], highlighting higher percentages of severe sarcopenia in participants with diabetes [27 (8.6%) vs. 58 (5.2%), p = 0.028]. Confirmed or severe sarcopenia was detected in 41 (13%) participants with diabetes and 109 (9.8%) participants without diabetes (p = 0.108). According to BIS equation, sarcopenia was not significantly more prevalent in the more advanced stages of CKD (p = 0.845). In multivariate analyses, older age (odds ratios [OR], 1.17; 95% confidence interval [CI], 1.08–1.27), and lower body mass index (OR, 0.79; 95% CI, 0.71–0.89 were associated with the presence of sarcopenia. Conclusions One tenth of all older community-dwelling subjects have sarcopenia. Older age and being thinner, but not worse renal function, were associated with higher prevalence of sarcopenia in older older adults with diabetes.

Sarcopenia is associated with a greater risk of polypharmacy and number of medications: a systematic review and meta‐analysis

“…Subjects with sarcopenia had a greater prevalence of malnutrition in eight studies as opposed to subjects without sarcopenia 46–48,53,55,61,69,71 ; in three studies, they had greater prevalence of general comorbidities 49,56,62 ; in two studies, they had a greater prevalence of depression, 48,67 a higher prevalence of dementia 45,46 and type 2 diabetes 46,50 ; and in one study, they had higher prevalence of osteoporosis 69 and respiratory disease 52 . Nevertheless, nine studies displayed similar rates of general comorbidities between subjects with sarcopenia compared with those without sarcopenia, 44,55,57,59,60,63,65,66,71 while in four studies, subjects without sarcopenia had a higher prevalence of hypertension 52,53,58,64 ; in one study, they had a higher prevalence of type 2 diabetes 58 ; and in one study, they had a higher prevalence of chronic kidney disease 52 compared with subjects with sarcopenia.…”

“…Seventeen studies assessed the prevalence of polypharmacy 25,45–60 and 13 studies assessed the number of medications received 44,46,61–71 . The study by Suzan et al was included in the analysis of both groups (prevalence of polypharmacy and number of medications) 46 .…”

“…Five studies were conducted in Japan, 25,47,50,57,69 five in Turkey, 46,55,66,68,70 four in Italy, 44,45,63,67 three in China, 52,53,65 two in Germany, 54,71 two in Australia, 56,60 two in South Korea, 48,51 one in Spain, 62 one in United Kingdom, 49 one in Belgium, 61 one in Taiwan, 59 one in Malaysia 58 and one in multiple European countries. 64 Eighteen studies were cross-sectional [44][45][46][47]50,52,54,55,57,59,[62][63][64][65][66][68][69][70] and six longitudinal, 48,51,53,…”

“…Eighteen studies included subjects with sarcopenia with mean age 80 years and above, 44,45,47,48,[51][52][53]55,56,59,60,[62][63][64]67,[69][70][71] while 11 studies included subjects with sarcopenia with mean age below 80 years. 25,46,49,50,54,57,58,61,65,66,68 Subjects with sarcopenia had a greater prevalence of malnutrition in eight studies as opposed to subjects without sarcopenia [46][47][48]53,55,61,69,71 ; in three studies, they had greater prevalence of general comorbidities 49,56,62 ; in two studies, they had a greater prevalence of depression, 48,67 a higher prevalence of dementia 45,46 and type 2 diabetes 46,50 ; and in one study, they had higher prevalence of osteoporosis 69 and respirat...…”

Current and Emerging Pharmacotherapeutic Interventions for the Treatment of Peripheral Nerve Disorders

“…This association between peripheral neuropathy and age was also reflected in a study with middle-aged (40–69) and older (>70 years) adults from two cohorts in the United States ( n = 8562) [ 15 ]. Sarcopenia is also associated with metabolic conditions, being involved in up to 10.6% of patients with diabetes [ 16 ] and is known to be a marker of frailty [ 17 ] along with malnutrition [ 18 ]. These may further exacerbate the course of peripheral neuropathy, especially in elderly individuals.…”