Study On The Relationship Between Skeletal Muscle Mass Index And Glucose And Lipid Metabolism In Type 2 Diabetes Patients

Objective To explore the relationship between the limb skeletal muscle mass index（ASMI）,the whole body skeletal muscle mass index（SMI）and glucose and lipid metabolism in patients with type 2 diabetes（T2DM）,and to provide new ideas for the di A/Gnosis and treatment of diabetes patients.Methods From June 2021 to January 2023,565 T2DM patients（333 males and232 females）were included in the Endocrinology Department of Lanzhou University First Hospital.The total skeletal muscle mass was measured by dual energy X-ray absorption method,and ASMI and SMI were calculated.Male and female T2DM patients were divided into E_1-4groups and T_1-4groups according to the quartile level of ASMI and SMI.Compare the differences of glucose and lipid metabolism indicators between groups with different levels of ASMI and SMI.Spearman analyzed the correlation between various glucose and lipid metabolism indicators and the levels of ASMI and SMI.Multiple linear regression analysis was used to analyze the independent correlation between ASMI,SMI,and glucose and lipid metabolism indicators.To compare the differences in the constituent ratios of different blood glucose levels and dyslipidemia in T2DM patients with different levels of ASMI and SMI.Ordered logistic regression was used to analyze the risk factors of ASMI and SMI.Results1.After the ASMI level was grouped according to the quartile,the Hb A1c level[7.9（6.5-9.4）%]of male T2DM patients in group E₄was lower than that in group E₂[8.9（7.3-10.9）%,p<0.05];The 2-hour postprandial blood glucose（2h PG）levels in the E₃group[（17.12±5.57）mmol/L]were lower than those in the E₂group[（19.33±5.53）mmol/L,p<0.05];The 2h PG levels in the E₄group[（15.81±4.85）mmol/L]were lower than those in the E₁and E₂groups[（18.08±5.23）mmol/L and（19.33±5.53）mmol/L,both p<0.05].The TG levels of male T2DM patients in the E₃and E₄groups[（1.95±1.75）mmol/L and（1.94±1.96）mmol/L]were higher than those in the E₁and E₂groups[（1.46±0.76）mmol/L and（1.39±0.6）mmol/L,p<0.05];The LDL-C level in the E₃group[（2.79±0.84）mmol/L]was higher than that in the E₂group[（2.52±0.76）mmol/L,p<0.05].2.The ASMI level in male T2DM patients is positively correlated with TG（r=0.255,p<0.05）,but negatively correlated with 2h PG and HDL-C（r=-0.168 and-0.117,p<0.05）.Ordered logistic regression analysis suggests that 2h PG is an independent risk factor for ASMI（B=-0.134,p<0.05）.As the ASMI level gradually increases,the proportion of T2DM patients with Hb A1c≤6%shows an upward trend;The proportion of T2DM patients with Hb A1c>10%showed a decreasing trend（X²=14.798,P=0.022）;The proportion of patients with high TC shows a decreasing trend;The proportion of patients with high TG showed an increasing trend（X²=10.358,p=0.016;X²=9.078,p=0.028）.3.The Hb A1c levels in the T₄group of male T2DM patients[7.6（6.3-9.7）%]were lower than those in the T₃group[9（7.3-11.0）%,p<0.05];The 2h PG levels in the T₄group[（16.37±4.98）mmol/L]were lower than those in the T₁and T₃groups[（18.11±5.3）mmol/L and（18.18±5.25）mmol/L,both p<0.05].The TG levels in the T₃and T₄groups,[（1.79±1.73）mmol/L and（1.86±1.95）mmol/L]were higher than those in the T₁and T₂groups[（1.49±0.75）mmol/L and（1.59±0.82）mmol/L,p<0.05].4.The level of SMI in male T2DM patients is positively correlated with TG（r=0.176,p<0.05）;Negative correlation with HDL-C（r=-0.114,p<0.05）.Multiple linear regression suggests an independent negative correlation between SMI and HDL-C in male T2DM patients.As the level of SMI increases,the proportion of T2DM patients with Hb A1c≤6%shows an upward trend;The proportion of T2DM patients with Hb A1c>10%showed a decreasing trend（X²=12.64,p=0.049）;The proportion of T2DM patients with low HDL-C showed an increasing trend（X²=8.79,p=0.032）.5.There was no statistically significant difference in the levels of various glucose and lipid metabolism indicators among female T2DM patients with different levels of ASMI and SMI;There were no statistically significant differences in the constituent ratios of Hb A1c levels and dyslipidemia among different ASMI and SMI levels groups.Logistic regression suggests that there is no independent correlation between ASMI,SMI,and glucose and lipid metabolism indicators in female T2DM patients.Conclusion1.The skeletal muscle mass of male T2DM patients is closely related to glucose and lipid metabolism.As the skeletal muscle mass decreases,blood sugar levels gradually increase;TG levels gradually decrease.2.Male T2DM patients have a positive correlation between ASMI and TG levels,but a negative correlation with 2h PG and HDL-C levels;SMI is positively correlated with TG levels and negatively correlated with HDL-C levels.2HPG is an independent risk factor for ASMI in male T2DM patients.2h PG is an independent risk factor for ASMI.3.There is no correlation between skeletal muscle mass and glucose and lipid metabolism in female T2DM patients.