Abstract
Aims: The ratio of creatinine to cystatin C (Cre/CysC) has been proven to be a predictor of sarcopenia in patients with or without diabetes. Here, we investigated the predictive value of Cre/CysC in skeletal muscle composition and its correlations with glucose disposal ability and diabetic complications in patients with type 2 diabetes. Methods: The skeletal muscle index (SMI) and mean skeletal muscle attenuation (MMA) values of 193 patients with type 2 diabetes were obtained through analyses of CT images at the lumbar 3 level. Results: Serum Cre/CysC was significantly correlated with both the SMI (r =0.375, P < 0.001) and MMA (r = 0.378, P < 0.001). Multiple stepwise linear regression analysis demonstrated that Cre/CysC was the only biochemical predictor of the SMI [β = 0.48, (95% Cl, 0.02 to 0.94) and MMA [β= 0.57, (95% Cl, 0.14 to 1.01). In the complications analysis, Cre/CysC was negatively correlated with cardiovascular disease (r = -0.190, P = 0.008) and lower extremity arterial disease (r = -0.209, P = 0.004). Moreover, in the 100 g steamed bun test, Cre/CysC was significantly correlated with glucose levels at 60 min (r = -0.162, P = 0.045), 120 min (r = -0.287, P < 0.001) and 180 min (r = -0.313, P < 0.001). Conclusion: Cre/CysC is a valuable predictor of skeletal muscle composition in type 2 diabetes. Patients with higher levels of Cre/CysC may have a better ability to dispose of postprandial glucose and lower risk of macrovascular disease. Funding: The present study was supported by the Doctoral foundation of Affiliated Hospital of Jining Medical University (2020-BS-008). Declaration of Interest: The authors declare that they have no competing interests.
Highlights
Since the ratio of creatinine to cystatin C (Cre/CysC) can reflect muscle volume, it has been proven to be a predictor of sarcopenia in patients with or without diabetes
Considering that skeletal muscle is the main consumer of glucose and the main target of insulin activity [24], this study further evaluated the correlation between Cre/CysC and the 100 g steamed bun test
There was no correlation between Cre/CysC and HOMA2 indexes. These results indicate that patients with high levels of Cre/CysC may have better postprandial glucose disposal ability, even though they showed no differences in pancreatic function and insulin sensitivity
Summary
Since the ratio of creatinine to cystatin C (Cre/CysC) can reflect muscle volume, it has been proven to be a predictor of sarcopenia in patients with or without diabetes. In addition to common diabetic complications, the vasculopathy and accumulation of advanced glycation end-products can impair muscle mass and function, leading to sarcopenia [2]. Considering its heavy impact on quality of life and increased risk of fracture, disability and mortality, sarcopenia is emerging as a third category of diabetic complication [3, 4]. Several imaging modalities can be used to assess muscle mass and achieve the diagnosis of sarcopenia [5, 6]. Among these methods, magnetic resonance (MR) and computed tomography (CT) are considered to be gold standards for the non-invasive assessment of muscle mass [7]. In addition to the high cost, the equipment is not immediately accessible in primary care, and radiological technicians are required to operate it
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