Association of Glucose Fluctuations with Sarcopenia in Older Adults with Type 2 Diabetes Mellitus

Abstract

Type 2 diabetes mellitus accelerates loss of muscle mass and strength. Patients with Alzheimer’s disease (AD) also show these conditions, even in the early stages of AD. The mechanism linking glucose management with these muscle changes has not been elucidated but has implications for clarifying these associations and developing preventive strategies to maintain functional capacity. This study included 69 type 2 diabetes patients with a diagnosis of cognitive impairment (n = 32) and patients with normal cognition (n = 37). We investigated the prevalence of sarcopenia in diabetes patients with and without cognitive impairment and examined the association of glucose alterations with sarcopenia. Daily glucose levels were evaluated using self-monitoring of blood glucose, and we focused on the effects of glucose fluctuations, postprandial hyperglycemia, and the frequency of hypoglycemia on sarcopenia. Diabetes patients with cognitive impairment displayed a high prevalence of sarcopenia, and glucose fluctuations were independently associated with sarcopenia, even after adjusting for glycated hemoglobin A1c (HbA1c) levels and associated factors. In particular, glucose fluctuations were significantly associated with a low muscle mass, low grip strength, and slow walking speed. Our observation suggests the importance of glucose management by considering glucose fluctuations to prevent the development of disability.

A Narrative Review on Sarcopenia in Type 2 Diabetes Mellitus: Prevalence and Associated Factors

“…In epidemiological studies, glucose control, evaluated mainly by HbA1c, has not been found associated with sarcopenia in T2DM individuals. It is important to underline that although some studies have reported that HbA1c levels are not associated with impaired muscle quality [ 98 ], muscle strength [ 99 ], and physical performance [ 73 ], a relationship between glucose control and sarcopenia cannot be completely excluded; in fact, HbA1c levels do not adequately reflect all the aspects of the day-to-day blood glucose profile and, in particular, the occurrence of hypoglycaemic episodes and the daily glucose fluctuations that may potentially represent risk factors for sarcopenia [ 100 ].…”

Metabolic and Nutritional Characteristics in Middle-Aged and Elderly Sarcopenia Patients with Type 2 Diabetes

“…T2DM patients are known to be at high risk of developing sarcopenia due to metabolic abnormalities and insulin resistance [ 8 , 15 ]. Not only the HbA1c level but also glucose fluctuations were significantly associated with a low muscle mass, low grip strength, and slow walking speed [ 16 ].…”

Nutrition Management in Older Adults with Diabetes: A Review on the Importance of Shifting Prevention Strategies from Metabolic Syndrome to Frailty

“…Recent studies have highlighted the relationship between blood glucose control and frailty. In addition, poor glucose control is associated with sarcopenia as well as cognitive decline [68]. Hyperglycemia induces muscle atrophy and protein catabolism by blocking ubiquitin-dependent degradation of the transcription factor KLF15 involved in skeletal muscle loss [69].…”

“…Hyperglycemia induces muscle atrophy and protein catabolism by blocking ubiquitin-dependent degradation of the transcription factor KLF15 involved in skeletal muscle loss [69]. Although the mechanism is not yet known, hypoglycemia is expected to negatively affect muscle homeostasis as fluctuations in blood glucose induce oxidative stress [68].…”