Aging, physical activity, and diabetic complications related to loss of muscle strength in patients with type 2 diabetes

Nomura, Takuo; Kawae, Toshihiro; Kataoka, Hironao; Ikeda, Yukio

doi:10.1298/ptr.r0002

Cited by 31 publications

(22 citation statements)

References 33 publications

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“…Additionally, we found that the presence of micro- and macrovascular complications was higher in patients with physical inactivity. This is in line with a recent review on diabetic polyneuropathy and nephropathy [ 35 ]. Interestingly, diabetic polyneuropathy is associated with lower muscle strength measured by knee extension force [ 25 , 32 , 35 ], providing an alternative cause of muscle mass decline in addition to reduced dietary protein intake.…”

Section: Discussionsupporting

confidence: 92%

Low Physical Activity in Patients with Complicated Type 2 Diabetes Mellitus Is Associated with Low Muscle Mass and Low Protein Intake

Hagedoorn

Braber

Oosterwijk

et al. 2020

JCM

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Objective: In order to promote physical activity (PA) in patients with complicated type 2 diabetes, a better understanding of daily movement is required. We (1) objectively assessed PA in patients with type 2 diabetes, and (2) studied the association between muscle mass, dietary protein intake, and PA. Methods: We performed cross-sectional analyses in all patients included in the Diabetes and Lifestyle Cohort Twente (DIALECT) between November 2016 and November 2018. Patients were divided into four groups: <5000, 5000–6999, 7000–9999, ≥ 10,000 steps/day. We studied the association between muscle mass (24 h urinary creatinine excretion rate, CER) and protein intake (by Maroni formula), and the main outcome variable PA (steps/day, Fitbit Flex device) using multivariate linear regression analyses. Results: In the 217 included patients, the median steps/day were 6118 (4115–8638). Of these patients, 48 patients (22%) took 7000–9999 steps/day, 37 patients (17%) took ≥ 10,000 steps/day, and 78 patients (36%) took <5000 steps/day. Patients with <5000 steps/day had, in comparison to patients who took ≥10,000 steps/day, a higher body mass index (BMI) (33 ± 6 vs. 30 ± 5 kg/m2, p = 0.009), lower CER (11.7 ± 4.8 vs. 14.8 ± 3.8 mmol/24 h, p = 0.001), and lower protein intake (0.84 ± 0.29 vs. 1.08 ± 0.22 g/kg/day, p < 0.001). Both creatinine excretion (β = 0.26, p < 0.001) and dietary protein intake (β = 0.31, p < 0.001) were strongly associated with PA, which remained unchanged after adjustment for potential confounders. Conclusions: Prevalent insufficient protein intake and low muscle mass co-exist in obese patients with low physical activity. Dedicated intervention studies are needed to study the role of sufficient protein intake and physical activity in increasing or maintaining muscle mass in patients with type 2 diabetes.

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Section: Discussionsupporting

confidence: 92%

Low Physical Activity in Patients with Complicated Type 2 Diabetes Mellitus Is Associated with Low Muscle Mass and Low Protein Intake

Hagedoorn

Braber

Oosterwijk

et al. 2020

JCM

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“…A Mann-Whitney's U-test, t-test, and χ2 test were used to compare background factors and indices of physical functioning between the two groups with reamputation histories versus groups with no reamputation histories, depending on the data characteristics. Multivariate Cox regression analysis was also performed after adjusting for confounding by inputting sex [2], age [10], serum albumin levels [26], and knee extensor muscle strength [27] as covariates with reference to items that were signi cant in univariate analysis and previous studies to identify factors associated with reamputation. To account for multicollinearity in this process, variables that were considered clinically important were left in the model if the absolute value of the correlation coe cients between the independent variables was greater than 0.7.…”

Section: Discussionmentioning

confidence: 99%

Reamputation in patients with diabetic-related minor amputations who underwent physical therapy during their hospitalization. A single-facility retrospective cohort study

Imaoka¹,

Sato²,

Furukawa³

et al. 2020

Preprint

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Background: Diabetic foot lesions are a major cause of non-traumatic lower limb amputations; they can interfere with daily life, reduce physical function and lower a patient’s quality of life. Physical therapy is necessary to prevent such social disadvantage. Patients at high risk of reamputation may require physical therapy to prevent reamputation. The purpose of this study was to elucidate the factors that influence re-amputation in patients with minor amputations who were treated with physical therapy during their hospitalization.Methods: This was a retrospective cohort study of 245 consecutive hospitalized patients who presented to our Wound Care Center between January 2015 and February 2018 and received physical therapy after a minor amputation. Participants were identified from admission records (to surgical and physical therapy units) stored in the electronic medical records. We examined reamputations that occurred in the ipsilateral lower extremity during the 1-year post-discharge outpatient period. The maximum follow-up period was１year. We used Cox proportional hazards analysis to examine factors affecting the risk of reamputation.Results: Of the 129 patients enrolled, 42 patients (32.5%) underwent reamputations during an average observation period of 6.2 months (range, 2.1 to 10.9 months). The factors associated with reamputation were a requirement for hemodialysis, ankle dorsiflexion angle, and ambulation Functional Independence Measure score.Conclusions: We identified a requirement for hemodialysis, ankle dorsiflexion angle, and functional independence measure (FIM) ambulation as the factors associated with reamputation in patients with diabetes who had undergone minor amputation. In the future, developing a physical therapy program that focuses on these factors could help reduce reamputations.

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“…Diabetes is a systemic disease and MTP joint deformity is likely to be a focal manifestation of multi-system deterioration [8,9]. Neural and motor dysfunction contribute to deficits in muscle strength [10][11][12], fatty infiltration of intrinsic foot muscle [13][14][15], and altered movements during functional tasks that have been correlated to MTP joint hyperextension [16]. In addition to neural and motor dysfunction, the vascular system has a number of DM-related impairments including peripheral artery disease, endothelial dysfunction [17], and blood flow dysregulation from autonomic nervous system dysfunction [18].…”

Section: Introductionmentioning

confidence: 99%

Multi-System Factors Associated with Metatarsophalangeal Joint Deformity in Individuals with Type 2 Diabetes

Zellers

Mueller

Commean

et al. 2020

JCM

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The underlying factors contributing to metatarsophalangeal joint deformity, a known precursor to skin breakdown in individuals with diabetes mellitus (DM), is likely to involve multiple body systems. The purpose of this cross-sectional study was to identify multi-system factors associated with metatarsophalangeal joint deformity in individuals with type 2 DM and peripheral neuropathy (n = 60). Metatarsophalangeal joint deformity was quantified with a computed tomography (CT) scan. System biomarkers included the musculoskeletal system (foot intrinsic muscle deterioration, tarsal/metatarsal bone mineral density, ankle dorsiflexion, metatarsophalangeal extension movement during a sit to stand task); the vascular system (ankle-brachial index); and the endocrine/immune systems (high sensitivity C-reactive protein, skin intrinsic fluorescence, and hemoglobin A1C). Muscle deterioration (r = 0.27), bone density (r = −0.35), metatarsophalangeal extension movement (r = 0.50), maximum dorsiflexion (r = −0.31), and ankle-brachial index (r = 0.33) were related to metatarsophalangeal joint deformity (p < 0.05). Bone mineral density and metatarsophalangeal extension movement were retained in a regression model relating to deformity (R2 = 0.34). All musculoskeletal system biomarkers and the ankle-brachial index demonstrated weak to moderate relationships to metatarsophalangeal joint deformity. Bone mineral density of the tarsal/metatarsal bones and extending the toes during a sit to stand task were the two strongest factors associated with metatarsophalangeal joint deformity. Evaluation and management of foot bone mineral density and toe extension movement pattern could reduce metatarsophalangeal joint deformity and the risk of skin breakdown and subsequent amputation.

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Aging, physical activity, and diabetic complications related to loss of muscle strength in patients with type 2 diabetes

Cited by 31 publications

References 33 publications

Low Physical Activity in Patients with Complicated Type 2 Diabetes Mellitus Is Associated with Low Muscle Mass and Low Protein Intake

Low Physical Activity in Patients with Complicated Type 2 Diabetes Mellitus Is Associated with Low Muscle Mass and Low Protein Intake

Reamputation in patients with diabetic-related minor amputations who underwent physical therapy during their hospitalization. A single-facility retrospective cohort study

Multi-System Factors Associated with Metatarsophalangeal Joint Deformity in Individuals with Type 2 Diabetes

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