Skeletal muscle as a treatment target for older adults with diabetes mellitus: The importance of a multimodal intervention based on functional category

Abstract

Although the lifespan of people with diabetes has increased in many countries, the age-related increase in comorbidities (sarcopenia, frailty and disabilities) and diabetic complications has become a major issue. Diabetes accelerates the aging of skeletal muscles and blood vessels through mechanisms, such as increased oxidative stress, chronic inflammation, insulin resistance, mitochondrial dysfunction, genetic polymorphism (fat mass and obesity-associated genes) and accumulation of advanced glycation end-products. Diabetes is associated with early onset, and progression of muscle weakness and sarcopenia, thus resulting in diminished daily life function. The type and duration of diabetes, insulin section/resistance, hyperglycemia, diabetic neuropathy, malnutrition and low physical activity might affect muscular loss and weakness. To prevent the decline in daily activities in older adults with diabetes, resistance training or multicomponent exercise should be recommended. To maintain muscle function, optimal energy and sufficient protein intake are necessary. Although no specific drug enhances muscle mass and function, antidiabetic drugs that increase insulin sensitivity or secretion could be candidates for improvement of sarcopenia. The goals of glycemic control for older patients are determined based on three functional categories through an assessment of cognitive function and activities of daily living, and the presence or absence of medications that pose a hypoglycemic risk. As these functional categories are associated with muscle weakness, frailty and mortality risk, providing multimodal interventions (exercise, nutrition, social network or support and optimal medical treatment) is important, starting at the category II stage for maintenance or improvement in daily life functions. Geriatr Gerontol Int 2022; 22: 110-120.

Association between diabetic peripheral neuropathy and sarcopenia: A systematic review and meta‐analysis

“…The presence of sarcopenia in patients with diabetes may have implications for treatment; for example, resistance-based multicomponent exercise may assist in building muscle mass and, subsequently, increase glucose sensitivity and improve glycemic control. 16 Nonetheless, it should be noted that this study has some limitations that may jeopardize the validity of the pooled analysis. Thus, the results should be carefully interpreted.…”

“…The presence of sarcopenia in patients with diabetes may have implications for treatment; for example, resistance‐based multi‐component exercise may assist in building muscle mass and, subsequently, increase glucose sensitivity and improve glycemic control 16 …”

A higher incidence of diabetic peripheral neuropathy may be associated with decreased sleep and increased depression in older adults

“…The effect of DPN on functionality in older adults is commonly seen in geriatric practice. Indeed, previous studies have shown that DPN affects both quality of life and daily functions, not only in the older adults but also in the general population (28,29). A study conducted on older adults found that DPN affects ADLs but not IADLs (8).…”

Influence of Discontinuation of Cardiac Rehabilitation in Elderly Outpatients Due to the COVID-19 Pandemic

“…In this study, the trunk muscle mass significantly increased after 3 months of CR in non-diabetic patients, but not in diabetic patients. The reason why diabetes accelerates the aging of skeletal muscle could involve oxidative stress, chronic inflammation, insulin resistance, mitochondrial dysfunction, and the accumulation of advanced glycation end-products [ 16 ]. If non-diabetic patients were to perform CR for longer in each session and/or increase the number of CR sessions per week, other muscle mass might increase.…”