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.

Keywords: Sarcopenia; Skeletal muscle mass; Type 2 diabetes.

Figure 1

Association between glycated hemoglobin (HbA1c) levels and sarcopenia in patients with type 2 diabetes. The frequency of sarcopenia by body mass index and plasma HbA1c levels. Study participants were subdivided at a body mass index (BMI) of 25 kg/m², a criterion of obesity in Japan, and 23.3 kg/m², which corresponds to the median among the remaining non‐obese participants. The numbers of participants in each BMI subgroup are shown in the columns and parentheses.

Figure 2

Adjusted odds ratio for sarcopenia in non‐obese patients. (a) General population (the Nagahama study). (b) Patients with type 2 diabetes. Patients whose body mass index was >25 kg/m² were excluded from the analysis. The odds ratio adjusted for age, sex and body mass index was calculated using the (a) intermediate or (b) lowest glycated hemoglobin (HbA1c) subgroup as a reference. T2DM, type 2 diabetes.