Abstract
BackgroundThe accelerated loss of muscle strength and mass observed in older type 2 diabetes mellitus (T2DM) patients due to the combined effects of diabetes and obesity, greatly increases their risk for sarcopenia. Early detection and treatment of probable and confirmed sarcopenia is paramount to delay mobility disability. Using low handgrip strength cut-off points for the initial identification of sarcopenia according to the new European Working Group on Sarcopenia in Older People (EWGSOP2) guidelines may mask the presence of sarcopenia. Relative knee extension strength cut-off points using a simple hand-held dynamometer can assist clinicians in the diagnosis of probable and confirmed sarcopenia by possibly reducing false negative results.MethodsA cohort of one hundred T2DM older patients (60% women) (mean age 74.5 years) mostly obese community dwelling older adults were evaluated for body composition by Bioelectrical impedance analysis (BIA), yielding appendicular skeletal mass index (ASMI) results. Patients underwent handgrip strength (HGS) and knee extension strength (KES) tests as well as functional ability tests. Prevalence of probable and confirmed sarcopenia using HGS and KES cut-off points were calculated. Pearson correlations were performed to evaluate the relationship between ASMI and limbs strength. A regression analysis was conducted to examine which variables best predict ASMI values. A multivariate analysis of covariance was performed to assess the effect of independent variables on KES and HGS.ResultsUsing cutoff points for low KES identified 24 patients with probable sarcopenia and two with confirmed sarcopenia. Conversely, using the EWGSOP2 cut off points for low HGS, identified only one patient with probable sarcopenia and none of the patients with confirmed sarcopenia.ConclusionKES cut-off points using a simple hand-held dynamometer can assist in the identification of probable and confirmed sarcopenia using EWGSOP2 cut off points for low muscle mass in a population of older T2DM patients for further analysis and early treatment. This is notably true in patients possessing high body mass index (BMI) alongside normal ASMI and HGS, potentially reducing false positive sarcopenia screening results.Trial registrationClinicalTrials.gov PRS: NCT03560375. Last registration date (last update): 06/06/2018. The trial was a-priori registered before actual recruitment of subjects.
Highlights
The prevalence of diabetes in the US is steadily increasing, reaching 26.8% (14% in men and 12% in women) among adults aged 65 years or older [1]
We evaluated the association between knee extension strength (KES) and handgrip strength (HGS) to appendicular skeletal mass index (ASMI), and the prevalence of low-test scores of sarcopenia parameters and common physical performance screening tests
The main finding of our study was that cut-off points for low KES identified considerably more patients with probable and confirmed sarcopenia compared to HGS testing using the EWGSOP2 cut-off points for low HGS
Summary
The prevalence of diabetes in the US is steadily increasing, reaching 26.8% (14% in men and 12% in women) among adults aged 65 years or older [1]. Compared to the general older population, studies evaluating sarcopenia in older T2DM patients are scarce with prevalence rates varying greatly, ranging from 7 to 29.3% [14]. This disparity is attributed mainly to variations between populations, variations in quantitative evaluation methods, as well as different diagnostic criteria [14, 15]. The accelerated loss of muscle strength and mass observed in older type 2 diabetes mellitus (T2DM) patients due to the combined effects of diabetes and obesity, greatly increases their risk for sarcopenia. Relative knee extension strength cut-off points using a simple hand-held dynamometer can assist clinicians in the diagnosis of probable and confirmed sarcopenia by possibly reducing false negative results
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