Time in range of glucose and sarcopenia in elderly patients with type 2 diabetes / 中华内分泌代谢杂志

ABSTRACT

Objective:To investigate the relationship between time in range(TIR) of glucose and sarcopenia in elderly patients with type 2 diabetes mellitus.Methods:A total of 673 patients with type 2 diabetes aged 65 years and above who were admitted to Henan Provincial People′s Hospital from March 2018 to July 2020 were selected. All patients completed questionnaire, physical and laboratory examination. Sensor-based flash continuous glucose monitoring(CGM) systems was used to monitor glucose levels, and the TIR was computed. Dual energy X-ray was used to assess total muscle mass and appendicular skeletal muscle mass index(ASMI) was calculated, the muscle strength was assessed with testing handgrip strength, and physical function was assessed by testing gait speed. Sarcopenia was diagnosed and graded according to the 2019 Asian Working Group on Sarcopenia(AWGSOP) standard. Patients with less than 3 days of CGM were excluded and a total of 658 subjects were included in the analysis.Results:The total prevalence of sarcopenia was 28.72%. Compared with non-sarcopenia group, TIR levels in the sarcopenia and severe sarcopenia groups were significantly decreased [55.0%(36.5%, 68.0%), 49.0%(31.0%, 70.5%) vs 66.0%(44.8%, 79.0%), both P<0.01]. The level of ASMI increased in line with TIR quartiles and topped in the fourth quartile group( P<0.05). Pearson correlation analysis showed that TIR was significantly positively correlated with ASMI, gait speed, and handgrip strength in male patients( P<0.05 or P<0.001), and TIR was significantly positively associated with ASMI and gait speed in female patients( P<0.05 or P<0.01). After logistic regression adjusted for gender, age, body mass index, blood pressure, disease duration, HbA 1C, fasting blood glucose, total cholesterol, triglyceride, low density lipoprotein-choresterol, high density lipoprotein-choresterol, estimated glomerular filtration rate, protein intake, exercise intensity, smoking and alcohol consumption, an increase in TIR levels was associated with a decrease in the prevalence of severe sarcopenia( OR=0.923, 95% CI 0.878-0.970, P=0.002). The lowest quartile TIR significantly increased the risk of sarcopenia compared with the highest quartile TIR( OR=3.733, 95% CI 1.129-12.342, P=0.031). Conclusion:Decline in TIR is significantly associated with an increased risk of sarcopenia in older patients with type 2 diabetes.