Correlation Between Muscle Mass Loss And Urine Microalbumin In Patients With Type 2 Diabetes

Objective To explore the related factors of muscle mass loss in patients with type2 diabetes(T2DM),and to analyze the relationship between muscle mass loss and urinary microalbumin in T2DM patients,and to provide a theoretical basis for further research on the underlying molecular mechanism between the two.Method A cross-sectional survey method was used to select T2DM patients admitted to the Endocrinology Department of the Affiliated Hospital of Qingdao University from January 2019 to August 2019.A total of 369 patients with T2DM were included,including 155 patients with reduced muscle mass and non-muscle reduced patients 214 cases.All subjects signed informed consent and performed a dual-energy X-ray bone densitometer(DXA)examination.At the same time,age,gender,body mass index(BMI),smoking and drinking history,diabetes duration,blood index,Urinary albumin-creatinin ration(UACR),fatty liver,appendicular skeletal muscle index(ASMI),visceral fat/subcutaneous fat(VAT/SAT),abdominal fat percentage/hip fat percentage(A/G),grip strength and pace.According to the diagnostic criteria of the Asian Sarcoma Working Group(AWGS),compare the prevalence of sarcopenia and muscle loss,and then compare whether there is a difference between the prevalence and sex.Secondly,the study subjects were divided into muscle loss group and non-muscle loss group,and the baseline data of muscle loss in T2DM patients were analyzed.All subjects were divided into group 1(18.0-39.9 years old),group 2(40.0-59.9 years old),group 3(60.0-79.9 years old),and group 4(80.0 years old and above)according to age,and the muscle mass of each age group was compared.Reduce the prevalence,and analyze the prevalence,grip strength,pace,and ASMI to correlate with age,and group by sex to compare the prevalence of muscle loss between men and women of all ages,and analyze the prevalence Whether it is related to age.According to BMI,all subjects were divided into group 1(<18.5Kg/m~2),group 2(18.5-23.9Kg/m~2),group 3(24.0-27.9Kg/m~2),group 4(28.0Kg/m~2 and above),Analyze the prevalence of muscle mass loss,grip strength,pace and whether there is a correlation between ASMI and BMI.According to 25(OH)D,all subjects were divided into group 1(<10ng/ml),group 2(10.0-19.9 ng/ml),group 3(20.0-29.0ng/ml),and group 4(30.0ng/ml and above),compare the prevalence of muscle loss in each group,and group by sex,compare the prevalence of muscle loss between men and women in each group,and analyze whether there is a correlation between prevalence and vitamin D levels.Logistic regression was used to analyze the protective factors and risk factors of muscle mass loss in T2DM patients.Finally,according to whether UACR is positive,the patients with reduced muscle mass were divided into proteinuria group(UACR?30mg/g)and non-proteinuria group(UACR<30mg/g),and the muscle,fat content and muscle fat in each part of the body were analyzed.Is there any difference in the ratio.Results(1)According to the diagnostic criteria of AWGS,the prevalence of sarcopenia in T2DM patients is 11.38%,and the prevalence of muscle mass loss is42.01%,of which 54.19%are male and 49.53%are female.There is no statistics on gender between the two groups.Significance(P>0.05).(2)The age,systolic blood pressure,high-density lipoprotein cholesterol(HDL-C),UACR,VAT/SAT,and A/G of the muscle-loss group were significantly higher than those of the non-muscle-loss group(all P<0.05).The BMI,insulin resistance index(HOMA-IR),glomerular filtration rate(eGFR),ASMI,grip strength,and fatty liver in the muscle loss group were significantly lower than those in the non-muscle loss group(all P<0.05).The two groups in the course of diabetes,diastolic blood pressure,fasting blood glucose(FBG),fasting insulin(FINS),fasting C peptide(CP),glycated hemoglobin(HbA1c),total cholesterol(TC),triglycerides(TG),low density lipid Protein cholesterol(LDL-C),aspartate aminotransferase(AST),alanine aminotransferase(ALT),urea(Bun),creatinine(Cr),uric acid(UA),25-hydroxyvitamin D(25-(OH)D),bone There were no significant differences in calcium,C-reactive protein(CRP),stride,body fat,and smoking and drinking history(all P>0.05).(3)The patients were grouped by age and sex.The prevalence of muscle mass loss in T2DM patients increased with age,and the trend test was statistically significant(P=0.000).The grip strength,stride speed,and ASMI were all related to age.Negative correlation(all P<0.05).The prevalence of muscle loss in male patients increased with age,and the trend test was statistically significant(P=0.000),while the prevalence of muscle loss in female patients increased with age,but the trend test was not statistically significant(P>0.05).(4)Patients were grouped by BMI.The prevalence of muscle mass loss in T2DM patients decreased with increasing BMI.The trend test was statistically significant(P=0.000),and ASMI was positively correlated with BMI(P<0.001),while grip strength There was no significant correlation between stride speed and BMI(all P>0.05).(5)Patients were grouped by vitamin D level and gender.The prevalence of muscle mass loss in T2DM patients had no significant correlation with vitamin D and gender(both P>0.05).(6)With or without muscle mass reduction as the dependent variable,age,BMI,systolic blood pressure,FINS,HOMA-IR,HDL-C,eGFR,UA,UACR,grip strength,pace,A/G,VAT/SAT,Multivariate logistic regression analysis was performed for fatty liver as the independent variable.The results showed that age,UACR,A/G,and VAT/SAT were risk factors for muscle mass loss,and BMI,eGFR,and grip strength were protective factors for muscle mass loss(all P<0.05).(7)Patients with reduced muscle mass were grouped according to UACR.There was no difference in upper limb muscle,upper limb fat,upper limb muscle/fat,lower limb muscle,lower limb fat,lower limb muscle/fat,abdominal muscle,abdominal fat,or abdominal muscle/fat.Significant difference(all P>0.05).Conclusions(1)The prevalence of decreased muscle mass increases with age.Therefore,it is necessary to screen for early sarcoma in elderly patients with T2DM,and grip strength can be used as a simple and fast screening index.(2)BMI is a protective factor for muscle mass loss,while A/G and VAT/SAT are risk factors for muscle mass loss.Therefore,in weight loss education for T2DM patients,the obesity characteristics of patients should be distinguished,and the focus on visceral obesity can reduce the incidence and development of sarcopenia,reduce the disability and mortality rates,and improve the quality of life of T2DM patients.(3)UACR is a risk factor for muscle mass loss in patients with T2DM,and eGFR is a protective factor for muscle mass loss.UACR is a sensitive indicator of early renal injury in patients with diabetes.The test is simple and fast,and it needs to be paid attention in clinical work.When T2DM patients detect a positive UACR and decrease eGFR,it may be considered that there may be a decrease in muscle mass.If necessary,early screening for sarcopenia is performed to reduce the incidence of clinical adverse events.