Association Of Atherosclerosis With Muscle Mass Loss In Elderly Patients With Type 2 Diabetes

Objective:To explore the risk factors of muscle loss in elderly patients with type 2 diabetes mellitus(T2DM),focus on the analysis of the relationship between muscle loss and atherosclerosis,provide a theoretical basis for further research on the underlying molecular mechanism between them.Method:322 ≥60 years old T2 DM patients were divided into muscle mass loss group(n=152)and non-muscle mass loss group(n=170)according to their appendicular skeletal muscle mass index(ASMI).All participants underwent physical examination,dual-energy X-ray absorptiometry(DXA)check,carotid and lower extremity ultrasound and laboratory test.The grip strength and pace of patients were detected.Age,gender,height,weight,diabetes course,drinking history,smoking history,coronary heart disease(CHD)history,high blood pressure(HBP)history,chronic complications of diabetes,drug application were collected.According to the diagnostic criteria of the Asian Sarcopenia Working Group(AWGS),the prevalence of sarcopenia and muscle mass loss in elderly patients with T2 DM were calculated.The baseline data of the two groups were analyzed,and logistic regression was used to analyze the protective factors and risk factors of muscle mass loss.The carotid artery and lower extremity atherosclerosis of patients were counted and graded according to the severity,and the consistency of the carotid atherosclerosis and lower extremity atherosclerosis grading was performed by Kappa test.According to consistency of arterial plaque formation in the carotid artery and the lower extremity,we divided the study subjects into non-plaque group(group 1),lower extremity arterial plaque group(group 2),carotid plaque group(group 3),and both plaque group(group 4).The ASMI between groups were analyzed by the variance to determine the correlation between ASMI value and the degree of atherosclerosis.Results:(1)A total of 322 patients were investigated,including 49 patients with sarcopenia,with a prevalence of 15.22%,and 152 patients with reduced muscle mass,with a prevalence of 47.2%,gender was not statistically significant between the two groups(P>0.05).(2)Body mass index(BMI),T-Score,ASMI,uric acid(UA)and homeostatic model assessment of insulin resistance(HOMA-IR)in the muscle mass loss group were significantly lower than those in the non-muscle mass loss group(P<0.05),the carotid atherosclerosis grade,lower extremity atherosclerosis grade,android fat/gynoid fat(A/G),visceral adipose tissue/subcutaneous adipose tissue(VAT/SAT)and visceral fat area(VFA)in the muscle mass loss group were significantly higher than that in the non-muscle mass loss group(P<0.05).There was no significant difference in course of disease,diabetes complications,gender,age,drinking history,smoking history,drug application history,body fat mass,waist circumference(WC),waist-to-hip ratio(WHR),alamine aminotransferase(ALT),aspartate aminotransferase(AST),blood urea nitroge(Bun),chrominum(Cr),blood calcium,blood phosphorus,alkaline phosphatase,fasting blood glucose(FBG),C peptide(CP),fasting insulin(FINS),glycated hemoglobin(Hb A1c),cholesterol(TC),triglycerides(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),Osteocalcin(OC),25-hydroxy vitamin D3 [25-(OH)D(3)],C reactive protein(CRP),grip strength,pace between the two groups(P > 0.05).Besides,multivariate Logistic regression analysis proved that age,carotid atherosclerosis,VFA,UA were risk factors for muscle mass loss(P=0.004;P=0.014;P=0.002;P=0.043);BMI,bone density and 25-(OH)D(3)were protective factors for muscle mass loss(P=0.001;P=0.031;P=0.048).(3)According to the atherosclerosis grading standard,the carotid artery atherosclerosis and lower extremity atherosclerosis of each patient were graded and Kappa test was performed on them.Carotid atherosclerosis grade and lower extremity atherosclerosis grade were consistent in elderly T2 DM patients(P<0.001;kappa=0.441).(4)Group patients according to the consistency of arterial plaque formation,the average ASMI of group 1 was 6.97 ± 1.31,the average ASMI of the group 2 was 6.65 ±1.54,and the average ASMI of the group 3 was 6.33 ± 1.2,and the average ASMI of group 4 was 6.28 ± 1.24.The analysis of variance showed that the ASMI values of the carotid plaque group and both-plaque group were significantly lower than non-plaque group respectively(P = 0.013;P <0.001).Conclusion:(1)The prevalence of sarcopenia in elderly patients with T2 DM is 15.22%,and the prevalence of muscle mass loss is 47.2%.The decline of muscle strength will lead to the loss of athletic ability,and is the main cause of disability,death and other adverse health consequences,which requires clinicians to pay great attention.(2)When elderly patients with T2 DM have atherosclerosis,muscle mass loss should be taken into consideration.It is necessary to calculate the ASMI and improve the DXA examination to diagnose sarcopenia or muscle mass loss as soon as possible,provide early intervention and guidance,reduce the occurrence of clinical adverse events.(3)It is also necessary for elderly T2 DM patients with high visceral obesity indicators and high uric acid to be highly vigilant against muscle mass loss.