Relevant Factors Of Sarcopenia In Middle-aged And Elderly Patients With Type 2 Diabetes Mellitus

BackgroundSarcopenia is a degenerative syndrome characterized by decreased skeletal muscle mass,strength and function.As the regulator of glucose metabolism,muscle plays an important role in maintaining the balance and stability of blood glucose.Type 2 Diabetes Mellitus（T2DM）,as a chronic metabolic disease,is a risk factor for the occurrence of Sarcopenia in middle-aged and elderly people.It may be related to protein intake,exercise,blood glucose control level,course of diabetes,chronic complications of diabetes and other factors.At present,many studies have confirmed that type 2 diabetes mellitus is closely related to sarcopenia.Many factors affect the occurrence and development of muscle content and bone mineral density in type 2diabetes mellitus.This is worth further exploring,so as to provide evidence for preventing abnormal bone metabolism and muscle metabolism in patients with type 2diabetes mellitus.ObjectiveTo evaluate the risk of sarcopenia in middle-aged and elderly patients with type2 diabetes mellitus for the prevention and treatment of sarcopenia.Methods289 middle-aged and elderly patients with T2DM in the Department of Endocrinology,First Affiliated Hospital of Zhengzhou University from May to November 2018 were studied and 57 healthy people during the same period were selected as the control group.Record general clinical data such as gender,age,weight and diabetes course,calculate body mass index（BMI）.All objects were fasted for 8-10hours and then on the second day of the morning,blood samples were taken to measure fasting blood glucose（FBG）,blood phosphorus,blood calcium,total cholesterol（TC）,triglycerides（TG）,high density lipoprotein（HDL）,low density lipoprotein（LDL）,glycosylated hemoglobin A1c（HbA1c）,25-hydroxyvitamin D₃（25（OH）D₃）and other indicators.The grip force was measured by CAMRY to evaluate the muscle strength.Using the American HOLOGIC dual-energy X-ray absorptiometry instrument to measure the skeletal muscle mass,body muscle content,bone mineral density（BMD）and abdominal fat area,calculate appendicular skeletal mass index（AMI）.The subjects were divided into T2DM group and normal control group.The difference of general data,biochemical indexes,HbA1c,both hands grip and other indicators between the two groups and the detection rate of sarcopenia between the two groups were compared.Pearson correlation analysis and Logistic regression analysis were used to analyze the risk factors of sarcopenia.Results（1）Comparison of detection rate of sarcopenia between T2DM group and normal control group:There were 289 persons in the T2DM group,including 145 males（35 cases of sarcopenia）and 144 females（31 cases of sarcopenia）.The detection rate of sarcopenia was 22.83%.There were 57 persons in the normal control group,including 23 males（5 cases of sarcopeina）and 34 females（2 cases of sarcopeina）.The detection rate of sarcopeina was 12.28%.The detection rate of sarcopenia in the T2DM group was higher than that in the normal control group.The detection rate was tested,P<0.05,the difference was statistically significant.（2）Comparison of general biochemical indicators between T2DM group and normal control group:（1）There was no significant difference in age,BMI,TG,blood calcium,blood phosphorus,left hand grip and right hand grip between the two groups（P>0.05）.（2）HDL,LDL and TCHO in T2DM group were lower than those in normal control group,P<0.05,the difference was statistically significant.（3）FBG and HbA1c in T2DM group were higher than those in normal control group,P<0.05,the difference was statistically significant.（3）Correlation analysis of skeletal muscle content with body weight,BMI,FBG,course of diabetes,total hip bone mineral density,25（OH）D₃ content,abdominal fat area and HbA1c in T2DM group:The Pearson correlation analysis shows:（1）The total skeletal muscle content was positively correlated with body weight and BMI.Pearson correlation coefficients were 0.78 and 0.54,P<0.05.（2）The skeletal muscle content was negatively correlated with FBG and duration of diabetes mellitus.Pearson correlation coefficients were-0.15 and-0.19,P<0.05.（3）The whole body skeletal muscle content was positively correlated with total hip bone mineral density,Pearson correlation coefficient was 0.52,P<0.05.（4）The muscle content of skeletal muscle was positively correlated with25（OH）D₃,Pearson correlation coefficient was 0.13,P<0.05.（5）The total skeletal muscle content was positively correlated with abdominal fat area,Pearson correlation coefficient was 0.344,P<0.05.（6）The Pearson correlation coefficient between the muscle content of skeletal muscle and HbA1c was 0.12,P>0.05.（4）Logistic regression analysis in T2DM group:Low BMI,low body weight,low abdominal fat area,low total hip bone mineral density,low 25（OH）D₃,and long course of diabetes are risk factors for sarcopenia.（5）The normal control group was divided into two groups according to whether or not there were sarcopenia.There were 7 patients in sarcopenia group,aged64.25±7.85 years,50 patients in non-sarcopenia group,aged 57.98±5.30 years.The age of sarcopenia group was older than that of non-sarcopenia group,P<0.05,the difference was statistically significant.（6）The normal control group was divided into normal BMI group（18-24kg/m²）and overweight and obesity group（BMI≥24 kg/m²）.Among them,there were20 cases in normal BMI group,including 6 cases of sarcopenia,37 cases in overweight and obesity group,including 1 case of sarcopenia.The detection rate of sarcopenia in overweight and obesity patients（2.70%）was lower than that in normal BMI patients（30.0%）,P<0.05,the difference was statistically significant.ConclusionT2DM patients are risk groups of sarcopenia.Age,low BMI,low 25（OH）D₃and long course of diabetes are risk factors for sarcopenia.Reduction of skeletal muscle content may be accompanied by osteopenia and osteoporosis.Intervention against the risk factors of sarcopenia should be established to reduced the occurrence of falls,fractures,disabilities and fatal events in T2DM patients.