Diabetes Can Accelerate Sarcopenia in the Diaphragm

Abstract

The diaphragm is a skeletal muscle that is involved not only in respiration but also in swallowing and lymphatic functions and maintaining posture. Only a few studies have described diaphragm thickness in patients with diabetes. Diaphragm thickness is usually evaluated using ultrasonography (U.S.). However, because evaluation of diaphragm thickness using U.S. is not routinely performed, it is difficult to assess it in a retrospective manner. Therefore, in this study, we developed a new method to evaluate diaphragm thickness in patients with diabetes using computed tomography (CT) and evaluated the correlation between U.S. and CT findings. Then, we evaluated the relationship among diaphragm thickness, age, and blood glucose metabolism. We prospectively evaluated the diaphragm thickness of 50 patients with diabetes using both U.S. and CT. The diaphragm thickness using CT was evaluated in the zone of apposition on contact with the thoracic cavity between the most frontal and dorsal positions, and the results were expressed as a sum of left and right measurements. The mean diaphragm thickness was 3.35 ± 0.64 mm and 3.73 ± 1.00 mm using U.S. and CT, respectively. The diaphragm thicknesses evaluated using both U.S. and CT were significantly correlated with each other (r = 0.3809, P = 0.0063). Then, we studied the data of 1patients with tuberculosis who had undergone CT and had a high morbidity of diabetes. The diaphragm thickness was positively correlated with body weight (r = 0.2911, P = 0.0088) and negatively with age and HbA1c (r = −0.4493, P < 0.0001; r = −0.5507, P < 0.0001, respectively). Moreover, the diaphragm thickness was significantly less in patients with diabetes than in those without diabetes. A thin diaphragm has been found to be related to poor prognosis among patients with acute pneumonia in intensive care units. Our results indicate that diabetes can accelerate sarcopenia of the diaphragm. Because the diaphragm has multiple functions, sarcopenia of the diaphragm in patients with diabetes might affect prognosis. Disclosure M. Yamamoto: None. M. Takemoto: None. H. Masuyama: None. M. Koshizaka: None. Y. Maezawa: None. K. Yokote: Research Support; Self; Astellas Pharm Ltd, MSD K.K..