Hyperglycemia in non‐obese patients with type 2 diabetes is associated with low muscle mass: The Multicenter Study for Clarifying Evidence for Sarcopenia in Patients with Diabetes Mellitus

Abstract

Aims/Introduction Hyperglycemia is a risk factor for sarcopenia when comparing individuals with and without diabetes. However, no studies have investigated whether the findings could be extrapolated to patients with diabetes with relatively higher glycemic levels. Here, we aimed to clarify whether glycemic control was associated with sarcopenia in patients with type 2 diabetes. Materials and Methods Study participants consisted of patients with type 2 diabetes (n = 746, the average age was 69.9 years) and an older general population (n = 2,067, the average age was 68.2 years). Sarcopenia was defined as weak grip strength or slow usual gait speed and low skeletal mass index. Results Among patients with type 2 diabetes, 52 were diagnosed as having sarcopenia. The frequency of sarcopenia increased linearly with glycated hemoglobin (HbA1c) level, particularly in lean individuals (HbA1c <6.5%, 7.0%, ≥6.5% and <7.0%: 18.5%; HbA1c ≥7.0% and <8.0%: 20.3%; HbA1c ≥8.0%: 26.7%). The linear association was independent of major covariates, including anthropometric factors and duration of diabetes (HbA1c <6.5%: reference; ≥6.5% and <7.0%: odds ratio [OR] 4.38, P = 0.030; HbA1c ≥7.0% and <8.0%: 4.29, P = 0.024; HbA1c ≥8.0%: 7.82, P = 0.003). HbA1c level was specifically associated with low skeletal mass index (HbA1c ≥8.0%: OR 5.42, P < 0.001) rather than weak grip strength (OR 1.89, P = 0.058) or slow gait speed (OR 1.13, P = 0.672). No significant association was observed in the general population with a better glycemic profile. Conclusions Poor glycemic control in patients with diabetes was associated with low muscle mass.

Alterations in the structural characteristics of rectus abdominis muscles caused by diabetes and pregnancy: A comparative study of the rat model and women

“…Reduced muscle fiber number and/or size is associated with a decrease in muscle function and can be caused by age [44], disuse [45] and illness [46]. Strong evidence suggests that diabetes is associated with muscular changes such as reduced muscle strength [47], power [48], mass [49], quality [48], and endurance and fiber type switch [6,50] termed as diabetic myopathy [6,51]. Our findings show that in the hyperglycemic environment, skeletal muscle in both rats and women decrease the number and area of fast fibers and an increase in the number of slow fibers.…”

Tracking the carbons supplying gluconeogenesis

“…In women, this effect was not seen leading to the potential sex differences in protein metabolism under diabetic conditions. T2DM is associated with lower skeletal muscle mass [84,85] and decreased muscle mass is correlated with poorer glycemic control [86]. Given these findings of decreased muscle mass with variable amino acid flux in T2DM, it remains difficult to quantify how much amino acids supply gluconeogenic carbons under diabetic conditions.…”

Glycemic Control and Insulin Improve Muscle Mass and Gait Speed in Type 2 Diabetes: The MUSCLES-DM Study

“…3 We previously reported a linear positive association between glycated hemoglobin (HbA 1c ) levels and frequency of sarcopenia in middle-aged to older patients with type 2 diabetes (age range: 38-96 years). 4 Another study in older patients with diabetes also reported HbA 1c !8.0% (64 mmol/mol) as a risk factor for the decline in muscle quality, independent of the duration of diabetes. 5 Additionally, a few studies found that blood glucoseelowering therapy with insulin sensitizers could prevent loss of muscle mass.…”