Sarcopenia: a chronic complication of type 2 diabetes mellitus

Abstract

BackgroundDiabetics are at increased risk for impaired mobility and strength, frequently related to the disease control. Sarcopenia is the reduction of muscle mass associated with the decrease in muscle strength and/or performance, resulting in worse morbidity in chronic diseases.MethodsThe objectives of this paper was to assess the prevalence of sarcopenia in patients with type 2 diabetes mellitus (T2DM) and determine its association with diabetes characteristics, progression, and complications, as well as changes in bone mineral density. The sample consisted of patients with T2DM followed at the outpatient clinics of the Serviço de Endocrinologia e Metabologia do Hospital de Clínicas da Universidade Federal do Paraná, from March to August 2016. Participants were men and women above 18 years with T2DM diagnosed at least 1 year earlier. Individuals with chronic diseases, users of any drug that modifies body composition, patients with body mass index (BMI) > 35 or < 18 kg/m2, and users of illicit drugs or hormonal or nutritional supplementation were excluded. The selected patients answered questionnaires about demographics, eating habits, and disease characteristics, and performed a bone densitometry exam in a dual energy absorptiometry (total body; spine and femur (total and neck)), a handgrip test by manual dynamometer, and an evaluation of the abdominal circumference (AC). The medical records were reviewed seeking diabetes data and laboratory test results. Patients were matched for sex, age, and race with healthy controls [Control Group (CG)]. The diagnosis of sarcopenia was conducted according to the criteria of the Foundation for National Institute of Health.ResultsThe final sample consisted of 83 patients in the DG and 83 in the CG. The DG had higher BMI, WC, past history of fractures and lower calcium and healthy diet intake (p < 0.005), compared to the CG. The DG presented a higher frequency of abnormal BMD (osteopenia in 45 (53%), and osteoporosis in 14 (19%)) and comorbidities than the CG (p < 0.005). Pre-sarcopenia was not different between groups, but muscle weakness was present in 25 diabetics (18 women) and only in 5 controls (4 men) (p = 0.00036). Sarcopenia was diagnosed in 13 (16.2%) patients in the DG and 2 (2.4%) in the CG (p = 0.01168). Pre-sarcopenia and sarcopenia were associated with altered BMD (p < 0.005), with no association with diabetes duration or control. Body mass index and osteoporosis increased the likelihood to have sarcopenia, but hypertension and healthy diet decreased it.ConclusionThe DG had altered BMD associated with worse glycemic control, and a higher prevalence of sarcopenia, suggesting the need to look for their presence in diabetics.

Predicting the risk of sarcopenia in elderly patients with patellar fracture: development and assessment of a new predictive nomogram

“…Therefore, maintaining a high BMI through intake of adequate nutrients can prevent the occurrence of postoperative sarcopenia in elderly fracture patients (Veronese et al, 2019). More than 422 million people worldwide have been estimated to have diabetes (Cameron et al, 2008), and sarcopenia has been reported as a complication of diabetes (Kalyani et al, 2015;Trierweiler et al, 2018), Our study confirmed that diabetes was an important risk factor for muscle reduction in patients with patellar fractures. The incidence of sarcopenia has also been reported to be significantly high in patients with poor glycemic control, and sarcopenia in turn leads to the worsening of diabetes (Park et al, 2006).…”

Predicting the risk of sarcopenia in elderly patients with patellar fracture: Development and assessment of a new predictive nomogram

“…More than 422 million people worldwide have been estimated to have diabetes, 38 and sarcopenia has been reported as a complication of diabetes. 39,40 Our study confirmed that diabetes was an important risk factor for muscle reduction in patients with patellar fractures. The incidence of sarcopenia has also been reported to be significantly high in patients with poor glycemic control, and sarcopenia in turn leads to the worsening of diabetes.…”

MECHANISMS OF ENDOCRINE DISEASE: Sarcopenia in endocrine and non-endocrine disorders

“…The association with sarcopenia is three times higher among diabetics than controls, but it could be eight times higher (16%), as described by Trierweiler et al (35), and yet still greater in latent autoimmune diabetes of adult (LADA) patients (35%), relative to controls (9.8%) (39). The ability to recognize at-risk individuals, and take preventive actions or undertake treatment, could avoid further MM deterioration.…”

“…Damage to the skeletal muscles has been described as a new complication of diabetic patients attributed to their longer survival (35). Sarcopenia occurs earlier, between 50 and 60 years, in persons with type 2 diabetes mellitus (DM2) and is strongly associated with increased frailty, mortality, higher hospitalization rates, disability and cardiovascular events, relative to non-frail patients with diabetes (36).…”