Glycemic Control and Insulin Improve Muscle Mass and Gait Speed in Type 2 Diabetes: The MUSCLES-DM Study
Glycemic Control and Insulin Improve Muscle Mass and Gait Speed in Type 2 Diabetes: The MUSCLES-DM Study
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DOI：
10.1016/j.jamda.2020.11.003
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发表时间：
2021-04-05
影响因子：
7.6
通讯作者：
Rakugi, Hiromi
中科院分区：
文献类型：
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作者：
Sugimoto, Ken;Ikegami, Hiroshi;Rakugi, Hiromi
目的：2型糖尿病是肌肉减少症的危险因素。使用降血糖疗法预防肌肉减少症的证据有限。我们旨在研究2型糖尿病患者血糖控制变化与肌肉减少症之间的关系以及抗糖尿病药物对肌肉减少症的作用。设计：我们进行了一项观察性纵向研究。环境和参与者：在一项正在进行的多中心研究中，共有588名日本糖尿病患者完成了为期1年的肌肉减少症和临床数据的随访测量。方法：对澄清糖尿病患者肌肉减少症证据的多中心研究（MUSCLES-DM研究）的数据集进行分析。结果：随访期间，骨骼肌减少症发生率略有增加，骨骼肌质量指数（SMI）均值、握力、步态速度均无变化。然而，根据糖化血红蛋白（HbA(1c)）值的变化程度分为5组，HbA（1c）降低>= 1%的患者表现出SMI的显著增加。我们的分析显示步态速度有类似的结果，但握力没有。使用多元线性回归模型，我们发现>= 1%的HbA（1c）值下降是SMI和步态速度变化的独立决定因素。我们还确定，基线时胰岛素的使用是SMI变化的一个独立因素。结论和意义：在日本2型糖尿病患者中，不良血糖控制的纠正和胰岛素的使用与骨骼肌质量或步态速度的增加显著相关。目前的发现增加了我们对血糖控制对预防心血管疾病和肌肉减少症的重要性的认识。(C) 2020作者。由爱思唯尔公司代表AMDA（急性和长期护理医学协会）出版。这是一篇基于CC BY-NC-ND许可（http://creativecommons.org/licenses/by-nc-nd/4.0/）的开放获取文章。
Objectives: Type 2 diabetes is a risk factor for sarcopenia. Evidence on the prevention of sarcopenia using blood glucosee-lowering therapy is limited. We aimed to examine the relationship between changes in glycemic control and sarcopenia and the effect of antidiabetic agents against sarcopenia in patients with type 2 diabetes.Design: We conducted an observational longitudinal study.Setting and Participants: In total, 588 Japanese patients with diabetes of an ongoing multicenter study completed 1-year follow-up measurements for sarcopenia and clinical data.Methods: The data set of the Multicenter Study for Clarifying Evidence for Sarcopenia in patients with Diabetes Mellitus (the MUSCLES-DM study) was analyzed.Results: During the follow-up period, the frequency of sarcopenia marginally increased, and the means of skeletal muscle mass index (SMI), handgrip strength, and gait speed did not show any changes. However, on dividing into 5 groups depending on the degree of changes in glycated hemoglobin (HbA(1c)) value, the patients with a decrease of >= 1% in HbA(1c) exhibited a significant increase in SMI. Our analysis revealed similar results for gait speed but not handgrip strength. Using the multiple linear regression model, we identified that a >= 1% decrease in HbA(1c) value was an independent determinant of the changes in SMI and gait speed. We also determined that insulin use at baseline was an independent factor for the changes in SMI.Conclusions and Implications: Correction of poor glycemic control and use of insulin were significantly associated with the increase in skeletal muscle mass or gait speed in Japanese patients with type 2 diabetes. The current finding increases our understanding of the importance of glycemic control for the prevention of cardiovascular diseases and sarcopenia. (C) 2020 The Author(s). Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).