Relationship of Sarcopenia with Microcirculation Measured by Skin Perfusion Pressure in Patients with Type 2 Diabetes

Abstract

Background: Few studies have examined the relationship of sarcopenia with the microcirculation. The current study investigated the relationship of sarcopenia with microcirculatory function, as assessed by skin perfusion pressure (SPP), in type 2 diabetes mellitus (T2DM) patients. Methods: In total, 102 T2DM patients who underwent SPP measurements and bioelectrical impedance analysis (BIA) were enrolled in this cross-sectional study. SPP was assessed using the laser Doppler technique. Sarcopenia was defined as low height-adjusted appendicular muscle mass (men, <7 kg/m 2 ; women, <5.7 kg/m 2) using BIA. We divided the participants into two groups based on SPP (≤50 and >50 mm Hg), and an SPP below 50 mm Hg was considered to reflect impaired microcirculation. Results: Fourteen patients (13.7%) were diagnosed with impaired microcirculatory function of the lower limb based on SPP. The prevalence of sarcopenia in all subjects was 11.8%, but the percentage of patients with an SPP ≤50 mm Hg who had sarcopenia was more than triple that of patients with an SPP >50 mm Hg (28.6% vs. 9.1%, P=0.036). A significant positive correlation was found between SPP and appendicular muscle mass adjusted for height (P=0.041 for right-sided SPP). Multiple logistic regression analysis showed that patients with sarcopenia had an odds ratio of 4.1 (95% confidence interval, 1.01 to 24.9) for having an SPP ≤50 mm Hg even after adjustment for confounding factors. Conclusion: These results suggest that sarcopenia may be significantly associated with impaired microcirculation in patients with T2DM. Nonetheless, the small number of patients and wide CI require cautious interpretation of the results.

Discrimination between possible sarcopenia and metabolic syndrome using the arterial pulse spectrum and machine-learning analysis

“…For example, the capillary density in skeletal muscle has been found to be low in sedentary older adults with sarcopenia 6 . Significant positive correlations were found between skin perfusion pressure and appendicular muscle mass 10 . PAD can result in decreased blood flow to the lower extremities, with the underlying pathophysiology characterized by metabolic and structural myopathic changes in skeletal muscles 11 .…”

“…It has been suggested that sarcopenia is associated with vascular lesions and poor microcirculation 10 . For example, the capillary density in skeletal muscle has been found to be low in sedentary older adults with sarcopenia 6 .…”

“…The results obtained in the ML analysis (LDA) and from the self-developed scoring system indicated that these differences can be used to aid the discrimination of possible sarcopenia. It has been suggested that sarcopenia is associated with vascular lesions and poor microcirculation 10 . For example, the capillary density in skeletal muscle has been found to be low in sedentary older adults with sarcopenia 6 .…”

“…Lower muscle strength is associated with increases in metabolic syndrome (MetS) and type-2 diabetes mellitus 1 . Sarcopenia has been noted to be significantly associated with poor outcomes, cardiovascular events, and impaired microcirculation in patients with type-2 diabetes mellitus 10 . Peripheral arterial disease (PAD) is also noted to be accompanied by musculoskeletal abnormalities including sarcopenia 11 .…”

Preclinical study of diabetic foot ulcers: From pathogenesis to vivo/vitro models and clinical therapeutic transformation

“…Nishimoto removed the external iliac artery, the femoral artery and a portion of the saphenous artery to the knee. 78 Laser Doppler (LDPI) measurement of lower extremity blood flow 79,80 or skin perfusion 81,82 to assess the relative objectivity of animal models of ischemia can be used as a reference index to judge the differences in ischemic models in repeated trials. Moreover, LDPI is significant in the clinical evaluation of the prognosis of patients with ischemic diabetic foot, but the subjective variability in the determination of animal models is vast and is therefore not recommended as the main indicator for evaluating ischemia in animal models.…”