Background In this study, we investigated whether serum levels of advanced glycation end products (AGEs) independently correlated with relative muscle strength after adjustment for clinical variables including diabetic peripheral neuropathy in patients with type 2 diabetes. Relative muscle strength was defined as muscle strength (in decinewtons, dN) divided by total muscle mass (in kg). Methods We enrolled 152 ambulatory patients with type 2 diabetes. Each participant underwent measurements of muscle strength and total muscle mass. Serum levels of AGEs were determined. The Michigan Neuropathy Screening Instrument Physical Examination (MNSI-PE) was performed to assess diabetic peripheral neuropathy. Results The participants were divided into three groups on the basis of tertiles of serum AGEs levels. Significant differences were observed among the three groups in relative handgrip strength (71.03 ± 18.22, 63.17 ± 13.82, and 61.47 ± 13.95 dN/kg in the low-tertile, mid-tertile, and high-tertile groups, respectively, P = 0.005). The relative muscle strength of the ankle plantar flexors was higher in the low-tertile group than in the mid-tertile and high-tertile groups (107.60 ± 26.53, 94.97 ± 19.72, and 94.18 ± 16.09 dN/kg in the low-tertile, mid-tertile, and high-tertile groups, respectively, P = 0.002). After adjustment for MNSI-PE score and other clinical variables in partial correlation analysis, the correlations between serum levels of AGEs and the relative muscle strength of handgrip, ankle dorsiflexor, and ankle plantar flexor remained significant. Serum AGEs level was the only variable that remained significantly related to the relative muscle strength of handgrip, ankle dorsiflexor, and ankle plantar flexor when AGEs level, fasting plasma glucose, and glycated hemoglobin (HbA1c) were entered into multiple regression models simultaneously. Conclusions After adjustment for multiple factors including diabetic peripheral neuropathy, this study demonstrated that increased serum levels of AGEs were independently associated with decreased relative muscle strength in patients with type 2 diabetes. Compared with fasting plasma glucose and HbA1c, serum level of AGEs is more strongly associated with relative muscle strength.

Background. Guidelines for diabetes care recommend specific treatment goals for blood glucose, blood pressure and lipid control to prevent long-term complications of diabetes. However, there are few reports on the achievement of goals and its association with cardiovascular risks in patients with type 1 diabetes mellitus (T1D). Methods. We analyzed data for patients with T1D from the Taiwan Diabetes Registry to examine the status of goal attainments and 10- and 30-year risk estimates for atherosclerotic cardiovascular disease (ASCVD). Univariable and multivariable linear regression were performed to evaluate factors associated with ASCVD risk estimates. Treatment goals were defined as A1C < 7.0%, blood pressure < 130/80 mmHg, and LDL cholesterol < 100 mg/dl or total cholesterol < 160 mg/dl. Results. The percentage of subjects fulfilling all targets was 9.9%. Meeting more treatment goals was associated with decreased ASCVD risk estimates (geometric means [95% confidence interval (CI)] of 10-year risk estimate with none to all three goal attainments: 4.6% [3.2-6.5], 3.4% [2.7-4.2], 2.1% [1.7-2.6], and 1.7% [1.1-2.6]). Association was found between waist circumference and higher 10-year ASCVD risk in the multivariable regression analysis (β-coefficient 0.24, 95% CI 0.09-0.40; P=0.002). Conclusions. Attainment of two or more treatment goals is associated with lower short- and longer-term risk estimates for ASCVD in patients with T1D.