The Relationship Between Sarcopenia And Cognitive Impariment In Elderly Patients With T2DM

Purpose:Our country has the largest number of type 2 diabetes(T2DM)in the world,and the prevalence is still increasing year by year.Sarcopenia is age-related loss of muscle mass,plus low muscle strength,and/or low physical performance.T2 DM is an important risk factor for sarcopenia,which severely threats the life of the elderly.The prevalence of cognitive impairment(CI)in elderly patients with T2 DM is higher than that in the elderly with normal glucose tolerance,60% to 70% T2 DM patients have cognitive impairment in varying degrees,which is characterized by a series of symptoms such as memory,attention,executive ability decline,learning and motor coordination ability decline,and can seriously develop into dementia.Both sarcopenia and cognitive impairment are important complications of T2 DM,but the relationship between T2 DM related sarcopenia and cognitive impairment is not clear.This article intends to explore the correlation between sarcopenia and cognitive impairment in T2 DM elderly by detecting indicators such as muscle strength,physical function,appendicular skeletal muscle mass index,and overall cognitive function,so as to provides a theoretical basis for the prevention and treatment of cognitive decline in patients with type 2 diabetes and sarcopenia.Methods:A total of 100 patients with T2 DM who were all ≥60 years old and hospitalized in the Endocrinology Department of the First Affiliated Hospital of Nanchang University from September 2020 to February 2021.According to the diagnostic criteria for sarcopenia issued by the Asian Working Group for Sarcopenia in 2019,the patients were divided into T2 DM with SAC group(n=32)and Non-SAC group(n=68).Collecting patients’ general condition and vital signs: age,gender,educational background,calf circumference,blood pressure(BP),pulse pressure(PP),body mass index(BMI),education and course of disease and other baseline data;detecting glucose metabolism index: fasting blood glucose(FPG),fasting C peptide(FCP),fasting serum Irisin(FINS),glycosylated hemoglobin(Hb A1c),insulin resistance index(HOMA-IR),insulin secretion index(HOMA-β);detecting lipid metabolism indicators: triglycerides(TG),cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C);detecting bone metabolism and biochemical indicators: albumin(Alb),creatinine(Cr),uric acid(UA),homocysteine(HCY),calcium(Ca),phosphorus(P),25(OH)D,thyroid Parathyroid hormone(PTH).Detecting T2 DM comorbidities and complications: estimated glomerular filtration rate(e GFR),urinary albumin/creatinine ratio(UACR),bone density,fundus examination,electromy-ography;detecting sarcopenia related parameters: appendicular skeletal muscle mass(ASM),appendicular skeletal muscle mass index(ASMI),grip strength of both upper limbs,5-time chair stand test;detecting cognitive function: Montreal Cognitive Assessment Scale(Mo CA)evaluation.Counting whether there are differences in relevant indicators between SAC and Non-SAC groups in elderly T2 DM patients,and further exploring the correlation between sarcopenia and cognitive impairment in elderly T2 DM patients.Results:1.In terms of general conditions and vital signs,the average age of the T2 DM &SAC group was higher than that of the Non-SAC group;the BMI and calf circumference of the SAC group are lower than those of the Non-SAC group,and the differences between these two groups were statistically significant(P<0.05).There were no significant differences in gender,education background,blood pressure(BP),pulse pressure(PP),and course of disease between the two groups(P>0.05).2.In terms of glucose metabolism,lipid metabolism,bone metabolism and biochemical indicators,there were no statistical differences in the indicators between these two groups(P>0.05).3.In terms of complications and comorbidities,e GFR and bone mineral density in the T2 DM & SAC group were lower than those in the Non-SAC group(P<0.05);there ware no statistical differences in the prevalence of DPN,DKD,and DR between these two groups(P> 0.05).4.In terms of parameters related to sarcopenia,the ASMI and grip strength of both upper limbs in the T2 DM & SAC group were lower than those in the Non-SAC group,and the SAC group took more time to complete 5-time chair stand test than the Non-SAC group.The prevalence of sarcopenia in the SAC group was higher than that in the Non-SAC group(P<0.05).5.In terms of cognitive function,the Mo CA score of the T2 DM & SAC group was lower than that of the Non-SAC group,and the prevalence of cognitive impairment in the SAC group was higher than that of the Non-SAC group(P<0.05).6.Spearman correlation analysis found that Mo CA score was positively correlated with ASMI,muscle strength,and calf circumference in elderly T2 DM patients.7.Taking gender,age,BMI,smoker,HOMA-IR,albumin,25(OH)D,TCHO,bone density and sarcopenia as independent variables,the occurrance of cognitive impairment was taken as the dependent variable(1=Yes,0=No).Binary logistic regression analysis showed that male was an independent protective factor for CI(OR=0.142,P=0.009),sarcopenia and smoking were independent risk factors for CI(OR=4.326,P=0.041;OR=5.370,P=0.029).Conclusion:1.T2 DM & SAC group have lower Mo CA scores and higher prevalence of cognitive impairment than Non-SAC group;Binary logistic regression analysis showed that sarcopenia increased the risk of cognitive impairment,that is the elderly T2 DM patients with sarcopenia were more likely to have cognitive impairment.2.Elderly T2 DM patients with sarcopenia are closely related to cognitive impairment,and sarcopenia is an independent risk factor for cognitive impairment.In clinical practice,elderly T2 DM patients with sarcopenia should be promptly screened,prevented and treated for cognitive impairment.