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Sarcopenia risk parallels HbA1c in adults with type 2 diabetes
Among Japanese adults with type 2 diabetes the likelihood of developing sarcopenia rises as HbA1c increases, and the connection is driven primarily by decreases in skeletal muscle mass, according to findings published in the Journal of Diabetes Investigation.
“If glycemic control levels were identified as a risk factor for sarcopenia among patients with diabetes, the findings might be useful in diabetes care, as it will clarify the clinical importance of glycemic control in the prevention of not only end-organ damage, but also sarcopenia and frailty in old age,” Hiromi Rakugi, MD, PhD, of the department of geriatric and general medicine at Osaka University Graduate School of Medicine in Japan, and colleagues wrote.
Rakugi and colleagues measured grip strength, gait speed, appendicular lean mass, fat mass and body height to help identify instances of sarcopenia in a cohort of 746 adults with type 2 diabetes (mean age, 69.9 years; 39.7% women) from the MUSCLES-DM study who visited one of five medical sites in Japan from May 2016 to December 2017. The researchers also examined sarcopenia prevalence and the potential association with HbA1c levels in a cohort of 2,067 adults aged at least 60 years (mean age, 68.2 years; 65.2% women; 10.3% with type 2 diabetes) and a cohort of 559 adults aged 69 to 71 years and 79 to 81 years who did not have diabetes (mean age, 80.5 years; 46.3% women).
In the first cohort with type 2 diabetes, there were 52 cases of sarcopenia, which was confirmed by grip strength, gait speed or skeletal muscle index. A grip strength of less than 26 kg in men or less than 18 kg in women, a skeletal muscle index of less than 7 kg/m2 in men or less than 5.7 kg/m2 in women or a gait speed of less than 1 m per second were used as the cutoff points for diagnosis. Of the 52 cases of sarcopenia, 39 occurred in those with a BMI of 22.3 kg/m2 or less.
The prevalence of sarcopenia was also highest for those with an HbA1c of 8% or more (10%) compared with lower measures, with prevalence declining in a linear fashion, although this association only neared significance (P = .053).
In fully adjusted models, the odds for sarcopenia were significantly higher for those with an HbA1c level of at least 8% (OR = 7.65; 95% CI, 1.95-30) compared with those with an HbA1c level of at least 7% to less than 8% (OR = 4.48; 95% CI, 1.24-16.17), at least 6.5% to less than 7% (OR = 4.3; 95% CI, 1.11-16.65) and less than 6.5%, with the latter group used as reference. Additionally, HbA1c measures of at least 6.5% but less than 7% (OR = 3.29; 95% CI, 1.31-8.23), at least 7% and less than 8% (OR = 2.61; 95% CI, 1.09-6.24) and 8% or more (OR = 5.35; 95% CI, 2.07-13.86) were “specifically associated” with sarcopenia diagnosis via the skeletal muscle index criteria. In contrast, the researchers reported that associations between HbA1c and grip strength and HbA1c and gait speed did not reach significance.
According to the researchers, the odds for sarcopenia were increased for those in the original cohort with type 2 diabetes and higher HbA1c levels compared with those from the other cohorts, which had relatively lower HbA1c levels.
“The association between hyperglycemia and sarcopenia might be bidirectional. Although hyperglycemia could contribute to the longitudinal decline in muscle mass and strength, reduced glucose disposal capacity due to loss of muscle mass and quality might further deteriorate glucose metabolism,” the researchers wrote. – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.