The Relationship Between Sarcopenia And Arteriosclerosis In T2DM Patients And Construction Of Clinical Prediction Model For Arteriosclerosis

Objective: To understand the relationship between sarcopenia and arteriosclerosis in patients with type 2 diabetes mellitus(T2DM)and to build a clinical prediction model for the incidence of atherosclerosis.Methods: A total of 1355 T2 DM patients in the First Affiliated Hospital of Fujian Medical University were included in our study,709 are males and 646 are females,with an average age of 61.87±12.30 years old.All selected subjects have refined the collection of general information,and used the Appendicular Skeletal Muscle Index(ASMI)obtained by the dual-energy X-ray absorptiometry(DXA)for sarcopenia according to the diagnostic criteria of Asian sarcopenia Diagnosis: male <7.0 kg/m2,female <5.4 kg/m2,divided into 2 groups,namely the sarcopenia group and the non-sarcopenia group.All muscle/fat parameters were measured between the groups and evaluated for clinical correlation with arteriosclerosis.LASSO and binary logistic regression were used to select the optimal variables and construct the nomogram chart of the arteriosclerosis prediction model of diabetic patients,respectively.ROC curve,calibration curve and decision curve analysis are used to evaluate the discriminative ability and clinical applicability.Results:(1)The detection rate of sarcopenia in the overall subjects was 21.3%(289/1355).The parameters between the two groups were age,gender,hypoglycemic drugs,antihypertensive drugs,heart rate,albumin,TC,TG,glycosylated hemoglobin,BMI,WHR,LAP,VAI,upper limb muscle/fat,lower limb muscle/fat,trunk muscle/fat are all different(P<0.05),and the muscle/fat parameters of the sarcopenia group are lower than those of non-sarcopenia group;(2)There was a significant difference in muscle/fat parameters between the sarcopenia group and the non-sarcopenia group in both males and females(P<0.05).The muscle mass of diabetic patients decreases with age,and the fat mass increases with age.(3)In the correlation analysis,ba PWV is negatively correlated with ASMI,while for LAP and VAI,there is no correlation with ba PWV;(4)The multiple linear regressions of ba PWV and ASMI,LAP,VAI are performed respectively,only ASMI was an independent risk factor of ba PWV(b=0.119,P=0.010);(5)Finally,the clinical prediction model of arteriosclerosis was established for patients with T2 DM,and6 independent variables(age,diabetes course,heart rate,SBP,lower limb muscles,UACR)were selected through lasso regression and logistics regression to make a nomogram predictive model.Nomogram shows the accuracy of assessing the risk of arteriosclerosis in T2 DM patients.The area under the ROC curve is 0.834(95% CI:0.813-0.855),and the bootstrap-corrected C index is 0.831.The DCA curve shows that the nomogram is in a wide range and has good clinical applicability under the threshold probability.Conclusion: Sarcopenia is an independent risk factor of atherosclerosis in patients with T2 DM.The prediction model based on age,diabetes duration,heart rate,SBP,lower limb muscle(LLM)and UACR has certain clinical predictions for the risk of arteriosclerosis in diabetic patients.