Analysis Of Risk Factors For Sarcopenia In Diabetic Foot Patients And Its Correlation With Foot And Ankle Function

Objective:This study was a cross-sectional study to investigate the prevalence and possible risk factors of sarcopenia in patients with diabetic foot(DF),and to further explore the impact of DF combined with sarcopenia on foot and ankle function,in order to improve the quality of life of DF patients and reduce the risk of amputation and death.Methods:(1)A total of 108 patients with type 2 diabetic foot and 100 patients with type 2diabetes mellitus(T2DM)were enrolled in the study,and all of them signed the informed consent.Detailed medical history and physical examination were performed on the patients,and general clinical data such as age,gender,BMI,and course of disease were collected.Early morning fasting blood was collected,Glycated hemoglobin A1c(Hb A1c),fasting blood glucose(FBG),fasting C-peptide(C-P),Fasting insulin(FINS),albumin(ALB),triglyceride(TG),cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),blood urea nitrogen(BUN),creatinine(Cr),uric acid(UA),urine albumin/creatinine(UACR),white blood cell count(WBC)C-reactive protein(CRP),D-dimer and other laboratory examination data.Transcutaneous oxygen pressure(Tc PO2)was measured by a professional.Body composition was measured by dual energy X-ray absorptiometry(DXA)to obtain skeletal muscle mass index(ASMI),bone mineral content(BMC),and T values of lumbar spine and femoral neck.Grip strength and sit up test were measured.The severity of ulcer in patients with type 2 diabetic foot was evaluated by Wagner grading.AOFAS score scale was used to evaluate foot and ankle function.(2)SPSS26.0 was used for statistical analysis.The t test and Mann-Whitney U test were used for measurement data,and the chi-square test or Fisher’s exact test was used for count data.One-way analysis of variance,Kruskal-Wallis test and chi-square test were used to compare the data of multiple groups.Logistic regression was used for multivariate analysis.Results:(1)The prevalence of sarcopenia in type 2 diabetic foot patients was significantly higher than that in T2 DM patients(40.74%vs12%,P<0.001).There were statistically significant differences in ASMI,sit up test,AOFAS score,Hb A1 c,ALB,Cr,UACR,WBC,CRP between patients with type 2 diabetic foot and T2DM(P<0.05).There were statistically significant differences in age,duration of diabetes,lumbar T score,ASMI,grip strength,sit up test,AOFAS score,Tc PO2,C-P,FINS,ALB,UACR,WBC and CRP between patients with type 2 diabetic foot and patients with type 2 diabetic foot according to Wagner classification(P<0.05).(2)Age,duration of diabetes,sit-to-sit test,Wagner grade,UACR and CRP were significantly higher in patients with type 2 diabetic foot sarcopenia than those without(P<05),but lower in BMI,FINS,ASMI,AOFAS,Tc PO2 than in non-sarcopenia patients(P<0.05).Multivariate Logistic regression analysis showed that BMI,Tc PO2 and CRP were the influencing factors of sarcopenia in patients with type 2 diabetic foot [OR(95%CI)=0.753(0.622,0.912),0.905(0.843,0.972),1.049(1.008,1.091)].(3)In the study population,32% of the T2 DM patients had excellent foot and ankle function,33% had good foot and ankle function,32% had fair foot and ankle function,and3% had poor foot and ankle function.Among the patients with type 2 diabetic foot,11%had excellent foot and ankle function,28% had good foot and ankle function,37% had fair foot and ankle function,and 24% had poor foot and ankle function.The difference between the two groups was statistically significant(P<0.001).There were significant differences in age,BMI,duration of diabetes,foot disease,sarcopenia,grip strength,sit up test,lumbar T score,femoral T score,ALB,TG,Cr,UACR,D-dimer,and CRP(P < 0.05).Using partial correlation analysis,foot and ankle function remained significantly associated with ASMI after adjusting for age(P<0.001).Ordinal multinomial logistic regression showed that age,foot disease and sarcopenia were the main factors affecting foot and ankle function(P<0.001,P<0.001,P=0.02).(4)There were significant differences in age,BMI,duration of diabetes,ASMI,grip strength,sit up test,ALB and ALT in T2 DM patients(P<0.05).There were statistical differences in age,severity of sarcopenia,severity of ulcer,Tc PO2,grip strength,sit up test,lumbar T score,femoral T score,TG,HDL-C,D-dimer and CRP in patients with type 2diabetic foot(P< 0.05).Regression analysis showed that Tc PO2,age and sarcopenia were the main factors affecting foot and ankle function.Compared with patients with severe sarcopenia,patients with no sarcopenia,decreased muscle mass,and sarcopenia were 0.099(P=0.048),0.049(P=0.024),and 0.077(P=0.026)times more likely to have a lower grade of foot and ankle function,respectively.Conclusions:(1)The prevalence of sarcopenia in patients with type 2 diabetic foot was 40.74%,which was much higher than that in patients with type 2 diabetes mellitus.Regression analysis showed that BMI and Tc PO2 were the protective factors for sarcopenia in patients with diabetic foot,while CRP was the risk factor for sarcopenia in patients with diabetic foot.(2)Foot and ankle function remained significantly associated with ASMI after adjusting for age in this population(P< 0.001).Age,foot disease and sarcopenia were the main factors affecting foot and ankle function.(3)This study showed that the foot and ankle function of patients with diabetic foot was worse than that of patients with type 2 diabetes.Sarcopenia,age and Tc PO2 were the main factors affecting foot and ankle function.Therefore,it is necessary to pay close attention to diabetic foot patients with advanced age,decreased muscle mass and low Tc PO2 levels in clinical work,and intervene as soon as possible to reduce the damage of foot and ankle function and the risk of amputation and death.