Muscle Strength and Glycaemic Control among Patients with Type 2 Diabetes

Nonlinear association between triglyceride-glucose index and 28-day mortality in intensive care units: a multi-center retrospective cohort study

Background

The triglyceride-glucose (TyG) index, derived from the calculation of two biomarkers, fasting plasma glucose and triglyceride levels, is a reliable indicator of insulin resistance and has been demonstrated to be associated with the adverse clinical outcomes of patients in the intensive care unit (ICU). This study aims to investigate the relationship between the TyG index and the 28-day all-cause mortality of these patients during their ICU stay.

Methods

This study employed a multicenter retrospective cohort design, analyzing data from 18,883 ICU patients in the eICU database. We calculated the TyG index for each patient and assessed its association with 28-day all-cause mortality. The Cox proportional hazards model was utilized for analysis, adjusting for various clinical and laboratory variables to control for confounding factors. We performed sensitivity analyses, subgroup analyses, and interaction analyses to evaluate the robustness of the results.

Results

The study identified a significant positive correlation between the TyG index and 28-day all-cause mortality. Specifically, each one-unit increase in the TyG index corresponded to a 58% increase in mortality risk (HR=1.58, 95% CI: 1.25-2.00, P=0.0001). Additionally, the analysis revealed a non-linear threshold effect of the TyG index on mortality, with a cutoff point at 8.82; mortality was lower below this value and significantly increased above it. Sensitivity and subgroup analyses indicated robust findings, while E-value analysis suggested resilience against unmeasured confounding.

Conclusion

This study establishes the TyG index as an independent predictor of 28-day all-cause mortality in critically ill patients, highlighting its potential value in clinical management and risk assessment. By recognizing the non-linear effect of the TyG index, clinicians can more effectively adjust treatment strategies to reduce mortality among high-risk patients.

A systematic review and meta-analysis on effect of different exercise training on grip strength and upper extremity muscle strength in patients with type 2 diabetes mellitus

BACKGROUND

Individuals with type 2 diabetes mellitus (T2DM) are prone to musculoskeletal complications, particularly in the upper extremities (UE), which can significantly impair their grip strength and UE muscle strength. This review will provide valuable insights for developing optimized exercise interventions aimed at enhancing upper limb functionality and improving patient outcomes.

AIM

To determine the effect of different exercise training on grip strength & UE muscle strength in patients suffering from T2DM.

METHODOLOGY

A comprehensive search from electronic databases was performed based on the selection criteria and 13 randomized controlled trials (RCT's) were included in the study. Mean changes in grip strength and UE muscle strength were the primary outcome measures. Included studies ranked high on the PEDro rating scale and eta-analysis was performed by Rev Man 5.4 software.

RESULTS

Meta-analysis results indicated that there was a statistically significant improvement in UE muscle strength of experimental group when compared to control group (mean differences [MD] = 2.91, 95% confidence interval = 0.12, 5.71; p = 0.04) with moderate heterogeneity (I2 = 49%, p < 0.07). Grip strength improved significantly in the experimental group when compared to the control group with (MD = 2.93, 95% CL = -0.00, 5.86; p = 0.05) and moderate heterogeneity (I2 = 66%, p < 0.08).

CONCLUSION

This review indicated a positive role of supervised resistance & aerobic exercises on UE muscle strength in patients with T2DM. Due to lack of RCT's, grip strength needs to be explored by further investigations in these patients.

Gender-Specific Association of Handgrip Strength with Type 2 Diabetes Mellitus in Chinese Han Older Adults

PURPOSE

We aimed to analyze the relationship between handgrip strength/relative handgrip strength among older Han adults with type 2 diabetes mellitus (T2DM) by gender to determine the optimal cut-off value of grip strength for older adults.

METHODS

A multi-stage sampling method was used to conduct a questionnaire survey and physical examination of 6128 older adults in Anhui Province. Chi-squares tests, t-tests, analysis of variance, and logistic regression analysis were used to analyze the association between handgrip strength/relative handgrip strength and T2DM between the sexes. The decision tree model (CRT) was used to explore the predictive value of handgrip strength /relative handgrip strength on T2DM.

RESULTS

There was an association between handgrip strength and T2DM (P = 0.006, OR = 0.985, 95% CI = 0.975, 0.996), which was found in females (P = 0.013, OR = 0.978, 95% CI = 0.961, 0.995) but not in males (P = 0.125, OR = 0.989, 95% CI = 0.976, 1.003). Relative handgrip strength was also correlated with T2DM (P = 0.014, OR = 0.730, 95% CI = 0.568, 0.939), which was found in females (P = 0.003, OR = 0.534, 95% CI = 0.352, 0.809) but not in males (P = 0.432, OR = 0.879, 95% CI = 0.638, 1.212). The incidence of T2DM in elderly females with hypertension who were uneducated and with a handgrip strength of <17.350 kg was 24.3% (115 cases), whereas that in elderly females with hypertension and a relative handgrip strength of <0.240 was 29.0% (127 cases).

CONCLUSION

According to our results, handgrip strength and relative handgrip strength were associated with T2DM. People with hypertension had a higher risk of T2DM in women with a handgrip strength of ≤ 17.350kg and a relative grip strength of ≤ 0.240. Further research is needed to validate the effectiveness of this cut-off for implementing interventions and avoiding risks.

Increased serum levels of advanced glycation end products are negatively associated with relative muscle strength in patients with type 2 diabetes mellitus

BACKGROUND

In this study, we investigated whether serum levels of advanced glycation end products (AGEs) independently correlated with relative muscle strength after adjustment for clinical variables including diabetic peripheral neuropathy in patients with type 2 diabetes. Relative muscle strength was defined as muscle strength (in decinewtons, dN) divided by total muscle mass (in kg).

METHODS

We enrolled 152 ambulatory patients with type 2 diabetes. Each participant underwent measurements of muscle strength and total muscle mass. Serum levels of AGEs were determined. The Michigan Neuropathy Screening Instrument Physical Examination (MNSI-PE) was performed to assess diabetic peripheral neuropathy.

RESULTS

The participants were divided into three groups on the basis of tertiles of serum AGEs levels. Significant differences were observed among the three groups in relative handgrip strength (71.03 ± 18.22, 63.17 ± 13.82, and 61.47 ± 13.95 dN/kg in the low-tertile, mid-tertile, and high-tertile groups, respectively, P = 0.005). The relative muscle strength of the ankle plantar flexors was higher in the low-tertile group than in the mid-tertile and high-tertile groups (107.60 ± 26.53, 94.97 ± 19.72, and 94.18 ± 16.09 dN/kg in the low-tertile, mid-tertile, and high-tertile groups, respectively, P = 0.002). After adjustment for MNSI-PE score and other clinical variables in partial correlation analysis, the correlations between serum levels of AGEs and the relative muscle strength of handgrip, ankle dorsiflexor, and ankle plantar flexor remained significant. Serum AGEs level was the only variable that remained significantly related to the relative muscle strength of handgrip, ankle dorsiflexor, and ankle plantar flexor when AGEs level, fasting plasma glucose, and glycated hemoglobin (HbA1c) were entered into multiple regression models simultaneously.

CONCLUSIONS

After adjustment for multiple factors including diabetic peripheral neuropathy, this study demonstrated that increased serum levels of AGEs were independently associated with decreased relative muscle strength in patients with type 2 diabetes. Compared with fasting plasma glucose and HbA1c, serum level of AGEs is more strongly associated with relative muscle strength.

Protein Intake Among Patients with Insulin-Treated Diabetes is Linked to Poor Glycemic Control: Findings of NHANES Data

BACKGROUND

Nutrition therapy is considered a key component of diabetes management. Recently, high-protein diets have gained in popularity. Understanding the glycemic effect of dietary protein among patients with diabetes has been of particular interest.

METHODS

This study is based on NHANES data of 990 participants aged 40 years and older from the NHANES cohorts of 2011-2012 and 2013-2014 surveys. Glycosylated hemoglobin (HbA1c level) was used as indicator of glycemic control. Patients were categorized into quartiles for daily protein intake. Average protein intakes for patients in quartile 1 to quartile 4 were 35.5 g, 58.7 g, 79.9 g, and 131.6 g, respectively. Covariates included in the analysis were gender, age, race, caloric intake, muscle strength, education, income, smoking, sedentary lifestyle, alcohol consumption, and BMI.

RESULTS

After controlling for covariates, patients in quartile 4 of protein intake had 261% increased risk of poor glycemic control compared with those in quartile 1 (95% CI: 1.29-5.30). The association was not attenuated after further control for insulin use (OR = 1.94; 95% CI: 0.89-4.24). In conclusion, higher protein intake seems related to a worse glycemic control in diabetic subjects.

Associations between Grip Strength and Glycemic Control in Type 2 Diabetes Mellitus: the 2014-2019 Korea National Health and Nutrition Examination Survey

OBJECTIVES

Glycemic control is essential for preventing severe complications in patients with diabetes mellitus. This study investigated the association between grip strength and glycemic control in Korean adults with type 2 diabetes mellitus.

METHODS

From the Korea National Health and Nutrition Examination Survey, 2,498 participants aged over 19 years that patients with diabetes mellitus who did not have a history of cardiovascular disease or cancer were selected for analysis. Grip strength was assessed using a handheld dynamometer and was represented as age-specific and sex-specific tertiles. Multivariable logistic regression was performed to calculate the odds ratio (OR) and 95% confidence interval (CI) of glycemic control according to the grip strength tertiles.

RESULTS

A significantly lower probability (OR, 0.67; 95% CI, 0.47 to 0.97) for glycemic control was found in the lowest tertile of grip strength compared to the highest tertile. Furthermore, a subgroup analysis by sex only found significant associations between grip strength and glycemic control in males.

CONCLUSIONS

Lower grip strength was associated with poor glycemic control in patients with diabetes mellitus, especially in males. However, further studies are needed to confirm the causal relationship between grip strength and glycemic control.

What can hand grip strength tell us about type 2 diabetes?: mortality, morbidities and risk of diabetes

INTRODUCTION

Hand grip strength (HGS) has been determined as a simple and cost effective method for evaluating overall skeletal muscle strength and quality. It has been used in numerous clinical studies to examine the association between skeletal muscle and type 2 diabetes (T2D). Previous studies have shown that HGS is significantly associated with mortality and cardiovascular disease (CVD) in patients with T2D. As the prevalence of T2D has seen a steady increase globally, HGS measurement can be useful and essential in managing T2D.

AREAS COVERED

This narrative review summarizes the current evidence regarding the association between HGS and T2D. HGS has been considered a useful tool for identifying risks for T2D, CVD, and mortality and evaluating skeletal muscle strength and quality.

OPINION

HGS should be measured in all patients with T2D together with height, weight, and waist circumference. However, there is yet no standard method used in measuring for HGS. T2D patients with a low HGS can engage in resistance training more effectively with appropriate advice based on HGS. Future studies clarifying the genetic association between skeletal muscle and T2D are needed to provide individualized exercise therapy.

Nutrition in Patients with Type 2 Diabetes: Present Knowledge and Remaining Challenges

Unhealthy behaviours, including diet and physical activity, coupled with genetic predisposition, drive type 2 diabetes (T2D) occurrence and severity; the present review aims to summarise the most recent nutritional approaches in T2D, outlining unmet needs. Guidelines consistently suggest reducing energy intake to counteract the obesity epidemic, frequently resulting in sarcopenic obesity, a condition associated with poorer metabolic control and cardiovascular disease. Various dietary approaches have been proposed with largely similar results, with a preference for the Mediterranean diet and the best practice being the diet that patients feel confident of maintaining in the long term based on individual preferences. Patient adherence is indeed the pivotal factor for weight loss and long-term maintenance, requiring intensive lifestyle intervention. The consumption of nutritional supplements continues to increase even if international societies do not support their systematic use. Inositols and vitamin D supplementation, as well as micronutrients (zinc, chromium, magnesium) and pre/probiotics, result in modest improvement in insulin sensitivity, but their use is not systematically suggested. To reach the desired goals, patients should be actively involved in the collaborative development of a personalised meal plan associated with habitual physical activity, aiming at normal body weight and metabolic control.

Association Between Muscle Strength and Cystatin C-Based Estimated Glomerular Filtration Rate Among Middle-Aged and Elderly Population: Findings Based on the China Health and Retirement Longitudinal Study (CHARLS), 2015

Background

Patients with chronic kidney disease (CKD) are prone to muscle strength degeneration. However, the relationship between mild-to-moderate renal insufficiency and low muscle strength remains unclear. As cystatin C is not subject to muscular conditions and is a sensitive serum marker in preclinical renal disease, we aimed to investigate the association between estimated glomerular filtration rate (eGFR) based on cystatin C and muscle strength in the Chinese population.

Methods

This was a cross-sectional study enrolling 12,398 Chinese participants aged above 45 years (5762 men and 6636 women) from the 2015 China Health and Retirement Longitudinal Study. Handgrip strength (HGS) was used to assess muscle strength. Locally weighted scatterplot smoothing (LOWESS) curves were employed to visualize the relationships between eGFR and HGS. Multivariable logistic regression was conducted to analyze the correlation between kidney function and low muscle strength.

Results

Significant differences in HGS by CKD stage were observed in both sexes after adjusting for age and body mass index. LOWESS curves demonstrated concomitant decreases in HGS and kidney function at eGFR levels below 120 mL/min/1.73 m² in both sexes. According to multivariate logistic regression, participants with CKD stages 2 (odds ratio [OR]: 1.256, 95% confidence interval [CI]: 1.120–1.409), 3 (OR: 2.725, 95% CI: 2.2585–3.288), and 4–5 (OR: 3.069, 95% CI 1.747–5.392) had higher risk of low muscle strength than those who were normal or had CKD stage 1 after adjusting for demographic and clinical variables.

Conclusion

Our study illustrated that CKD stage was independently associated with low muscle strength in Chinese middle-aged and elderly populations.

Influence of glucose, insulin fluctuation, and glycosylated hemoglobin on the outcome of sarcopenia in patients with type 2 diabetes mellitus

AIMS

To explore the effects of glucose, insulin, and glycosylated hemoglobin (HbA1c) levels on the outcome of sarcopenia in patients with type 2 diabetes mellitus (T2DM).

METHODS

A total of 482 T2DM patients were enrolled in the follow-up study. The median follow-up time was 36 months. Muscle mass and HbA1c were measured in all participants. And glucose, C-peptide and insulin levels were measured at 0 min, 30 min, and 120 min after glucose load. We subsequently analyzed daily glucose fluctuations and islet function before and after readmission as well as the influence of their changes on sarcopenia outcome.

RESULTS

After glucose load, incident sarcopenia patients showed greater glucose fluctuations and worse islet function than did non-sarcopenia patients. As HbA1c and standard deviation of blood glucose (SDBG) increased, readmitted non-sarcopenia patients showed a significantly increased odds ratio of incident sarcopenia; however, only patients with higher quartiles were statistically significant. Increased ΔAUC-C-peptide reduced the risk of incident sarcopenia (P < 0.05).

CONCLUSIONS

Patients with incident sarcopenia have poor glucose regulation and insufficient insulin secretion. Furthermore, as HbA1c and SDBG increased, AUC-C-peptide and AUC-insulin decreased in readmitted non-sarcopenia patients, the risk of incident sarcopenia increased.

High BMI with Adequate Lean Mass Is Not Associated with Cardiometabolic Risk Factors in Children and Adolescents

BACKGROUND

Despite an increasing number of studies investigating the links between increased BMI and a better prognosis of cardiovascular disease, which has been termed the "obesity paradox," few of them take the lean mass into consideration.

OBJECTIVES

This study aimed to explore the associations of body composition compartments, especially the lean mass, with cardiometabolic abnormalities in children and adolescents.

METHODS

In a nationwide cross-sectional study of 6- to 18-y-old children (n = 8967, 50.1% boys), we measured body composition using DXA scan, and calculated BMI, fat mass index (FMI), and lean mass index (LMI). The exploratory outcomes were cardiometabolic abnormalities, including hypertension, dyslipidemia, hyperglycemia, and insulin resistance. Adjusted linear regression coefficients and ORs were calculated to assess the associations between body composition indicators and cardiometabolic abnormalities.

RESULTS

Unlike BMI and FMI, LMI was inversely associated with homeostasis model assessment of insulin resistance (β: -0.06; 95% CI: -0.09, -0.03; P < 0.001), fasting plasma glucose (β: -0.08; 95% CI: -0.11, -0.05; P < 0.001), non-HDL cholesterol (β: -0.10; 95% CI: -0.13, -0.08; P < 0.001), LDL cholesterol (β: -0.12; 95% CI: -0.14, -0.09; P < 0.001), and total cholesterol (TC) (β: -0.16; 95% CI: -0.19, -0.14; P < 0.001). After multivariable adjustment, all the odds of cardiometabolic abnormalities were increased from the lowest quartile to the highest quartile of BMI and FMI (P-trend < 0.05); however, the odds of high TC, high LDL cholesterol, hyperglycemia, and insulin resistance were decreased with LMI (P-trend < 0.05). Obese children with high LMI did not have significantly increased odds of high TC, high LDL cholesterol, and high non-HDL cholesterol compared with normal-weight children without high LMI.

CONCLUSIONS

Greater lean mass may have a protective impact on high TC, high LDL cholesterol, hyperglycemia, and insulin resistance in children and adolescents. This finding suggests that the "obesity paradox" may be partly explained by high lean mass.