Application Of Calf Circumference Measurement In Elderly Patients With Type 2 Diabetes

Objective:This study is to investigate the value of calf circumference in cardiovascular complications,sarcopenia and nutritional risk assessment in diabetic elderly patients,and to provide simple parameters for the prevention and treatment of diabetes in the basic medical institutions.Methods:Enrolled in the elderly over 65 years old,divided into diabetes group and normal glucose tolerance group.Asked about the medical history and recorded the history of smoking,history of drinking,history of coronary heart disease,history of hypertension and history of hyperlipidemia.Measured weight and height,calculated body mass index(BMI),and measured calf circumference(CC).Fasting blood was drawn and fasting plasma glucose(FPG),blood lipids,insulin(FINS),C-peptide(FCP),glycosylated hemoglobin(HbA1c),albumin(ALB),serum creatinine(Cr),hemoglobin(Hb),N-terminal pro-B-type natriuretic peptide(NT-proBNP),25-hydroxyvitamin D(25(OH)D),homocysteine(Hcy),C-reactive protein(CRP)were measured.Using FINS and FPG to calculate the homeostasis model assessment of insulin resistance index(HOMA-IR)as the evaluation indicator of IR,and calculate the homeostasis model assessment of insulin secretion index(HOMA-B)as the evaluation indicator of islet beta cell function.Blood was taken 2 hours after the meal,and postprandial plasma glucose(2 hPG),postprandial insulin(2 hINS),and postprandial C peptide(2 hCP)were measured 2 hours after the meal.The grip strength was measured using a dynamometer,the sarcopenia index was calculated based on the CC and grip strength values,and the nutritional risk screening score(NRS score)was obtained using the nutritional risk screening tool.Statistical methods were used to compare the differences between the above indicators in the diabetic group and the normal glucose tolerance group,and the differences in clinical indicators were compared by CC median grouping.The correlation between CC and the above indicators was further analyzed,the influencing factors of diabetes were judged by logistic regression analysis,and the cut-off points of CC predicting diabetes,coronary heart disease and nutritional risk were judged by ROC curve.Results:A total of 377 elderly patients were enrolled,including 119 patients with type 2 diabetes,with an average age of 76.10±4.79 years,92 males and 27 females;258 patients with normal glucose tolerance,with an average age of 75.38±5.24 years,200 males and 58 females.1.The diabetic group had smaller CC than the normal glucose tolerance group(P<0.05).Diabetic patients had higher prevalence of coronary heart disease and hypertension than those with normal glucose tolerance(P<0.05).Compared with the two groups,the diabetic group had higher blood glucose levels,and severe insulin resistance(P<0.05).Compared with normal glucose tolerance patients,diabetic patients had higher levels of NT-proBNP,Hcy,NRS score,lower grip strength and 25(OH)D levels,and higher sarcopenia index(P<0.05).2.The CC median 30cm was used as a tangent point and was divided into CC>30cm and CC?30cm groups.Comparisons between the two groups showed that CC?30cm group was older,more common in women,and had higher prevalence of diabetes and coronary heart disease,and lower prevalence of hyperlipidemia(P<0.05).Compared with CC>30cm group,CC?30cm group had lower BMI,lower levels of Hb,ALB,Cr,poorer islet function,lower grip strength levels,higher levels of NT-proBNP,CRP,NRS score and sarcopenia index(P<0.05).3.Correlation analysis showed that CC was positively correlated with prevalence of hyperlipidemia,BMI,Hb,ALB,2 hCP,FINS,2 hINS,HOMA-B,and grip strength(P<0.05).CC was negatively correlated with age,prevalence of diabetes,prevalence of coronary heart disease,NT-proBNP,CRP,NRS score,and sarcopenia index(P<0.05).4.Logistic regression analysis showed that age and CC were the independent influencing factors of diabetes(P<0.05).5.ROC curve analysis showed that CC could predict the occurrence of diabetes,coronary heart disease and nutritional risk(P<0.05).Conclusion:The measurement of calf circumference is of great significance in elderly patients with type 2 diabetes.Diabetic patients have smaller calf circumference than those with normal glucose tolerance,and the elderly with small calf circumference have high prevalence of diabetes and coronary heart disease,high risk of cardiovascular disease,poor heart function,high nutritional risk and high sarcopenia index.Calf circumference can be used as a simple indicator for the basic level detection to predict the occurrence of diabetes,coronary heart disease,nutritional risk and sarcopenia.