Hand Grip Strength Is Associated With Gender Difference Of Insulin Dosage In Patients With Newly Diagnosed Type 2 Diabetes Mellitus: A Cross-sectional Study

BackgroundDiabetes Mellitus is one of the most important chronic non-communicable diseases that threaten human health all over the world.It not only causes physical and psychological damage,but also brings heavy economic burden to individuals and society.Insulin and its analogues are the potent hypoglycemic agents and play a key role in the management of hyperglycemia and thus reducing the risk of diabetic complications in patients.The short-term intensive glycemic control by continuous subcutaneous insulin infusion(CSII)can significantly improve the pancreatic islet beta cell function and thus induce the clinical remission in patients with newly diagnosed type 2 diabetes mellitus(T2DM).We previously found that the female patients need higher daily insulin dosage per weight(IU/kg/d)than male counterparts to maintain euglycemia,even at the similar age,body mass index(BMI),homeostasis model for systemic cell function(HOMA-β),and homeostasis model of insulin resistance(HOMA-IR)levels.It suggests that there may be other mechanisms involved or that other factors are needed to be found out to explain these differences.ObjectiveThe aim of this study was to explore gender differences of anthropometry data,hand grip strength,usual gait speed and sex hormone levels,as well as daily insulin dosage in type 2 diabetic patients whose age,BMI,HOMA-β,and HOMA-IR at similar levels.And then to analyze the relationship between those above parameters and daily insulin dosage calculated after 7-8day period of CSII treatment.Finally,our study was to provide theoretical basis for the application of some predictors for daily insulin dosage in clinical practice.MethodThis was a cross-sectional study.Two researchers extracted the anthropometric and laboratory data,hand grip strength,usual gait speed,as well as daily insulin dosage from consecutive medical records of type 2 diabetic patients referred to the department of endocrinology of Nanjing First Hospital.Data analysis covered the period from June 2019 to December 2020.Those eligible patients were divided into two groups according the gender.The gender differences of anthropometric and laboratory data,hand grip strength,usual gait speed and daily insulin dosage were explored after matching for age,BMI,HOMA-β,and HOMA-IR.Pearson correlation and stepwise multiple Regression analysis were employed to seek the predictors for daily insulin dosage.Results1)Finally,108 eligible patients,including 60 males and 48 females,aged 55.53±9.87 years,BMI 25.01±2.87 kg/m~2,Hb A1c value 10.07±1.71%were enrolled and then divided into two groups by gender.There were no significant differences in age,course of disease,BMI,waist-hip ratio,blood pressure,liver function,estimated glomerular filtration rate,triglyceride,total cholesterol,low density lipoprotein,Hb A1c,HOMA-βand HOMA-IR between the two groups.Male patients had higher testosterone,free androgen index(FAI),body muscle-to-fat ratio(BMFR),skeletal Muscle-to-fat ratio(SFR),hand gait speed and usual grip strength(34.89±7.48 kg vs.22.36±7.38 kg)than that of the female group.2)There were no significant differences in pre-prandial and postprandial blood Glucose and mean blood glucose levels between the two groups after 7-8 day period of glycaemia control.The Daily Insulin dosage of the female group was higher than that of the male group(0.61±0.19 IU/kg/d vs.0.50±0.15 IU/kg/d)3)After adjusting for age,course of disease,BMI,waist-hip ratio,Hb A1c,HOMA-IR,HOMA-β,BMFR,SFR,FAI,testosterone and usual gait speed,the hand grip strength was still negatively correlated with DID(r=-0.339,P=0.003).The multivariate stepwise regression analysis indicated that hand grip strength was an independent predictor of DID in patients with T2DM,which accounted for 15.3%of DID changes.ConclusionThe female patients need higher DID(IU/kg/d)than male counterparts to maintain euglycemia.Lower hand grip strength was associated with a significantly increased DID.Hand grip strength was an independent predictor of DID in patients with T2DM,which could predict 15.3%of DID variance.The combination of hand grip strength,WHR and HOMA-IR accounted for 33.0%of DID variance.In summary,the difference in hand grip strength in T2DM patients is an important reason for the gender difference in DID.