Study On The Relationship Between Type 2 Diabetes With Decreased Skeletal Muscle Mass And Insulin Resistance And Risk Factors Of ASCVD

Objective:（1）To observe the prevalence of skeletal muscle mass loss and myopenia in T2DM and non T2DM populations,and analyze the clinical characteristics of T2DM patients with skeletal muscle mass loss and myopenia;（2）To explore the insulin resistance status of T2DM patients with reduced skeletal muscle mass,further explore the relevant risk factors of T2DM patients with reduced skeletal muscle mass and myopenia,improve the understanding of skeletal muscle mass and myopenia;（3）To analyze the correlation between T2DM with decreased skeletal muscle mass and risk factors for ASCVD,providing evidence for earlier prevention,treatment,and prediction of disease occurrence and development.Methods:This study is a cross-sectional study that included a total of 334 participants,216of whom were T2DM patients who visited the Endocrinology Department of the Second Affiliated Hospital of Nanchang University from June 2022 to January 2023.Among them,94 T2DM patients underwent grip strength testing,and 118 healthy individuals who were matched for both physical examination and grip strength testing at our hospital’s physical examination center during the same period.By reviewing their electronic medical records,collecting patient related information,using independent sample t-tests,non parametric Mann Whitney U-tests,Pearson correlation analysis,binary logistic regression analysis,and other statistical methods,the data was analyzed using SPSS 26.0 statistical software.Results:（1）Set the population with T2DM as the T2DM group,and the healthy physical examination population as the control group.Among the 334 study subjects,68 were accompanied by decreased skeletal muscle mass,including 52 in the T2DM group and 16 in the control group;Among the 212 study subjects who underwent grip strength testing,29 had sarcopenia,19 in the T2DM group,and 10 in the control group.Compared with the control group,the T2DM group had a decrease in skeletal muscle mass and a higher incidence of sarcopenia（24.07%vs 13.56%,20.21%vs8.5%）.The incidence of skeletal muscle mass reduction in the male T2DM group was higher than that in the male control group（25.00%vs 8.62%）,which was not observed in the female population;Compared with the control group,the T2DM group had larger WHR and TG,while 25-（OH）-D₃and grip strength were lower;In the presence of decreased skeletal muscle mass,the age and WHR of the T2DM group were higher than those of the control group;In the presence of sarcopenia,compared with the control group,the T2DM group had older age,WHR,and smaller grip strength,all of which were statistically significant（P<0.05）.（2）An analysis was conducted on 216 T2DM patients included,and the population aged<45,45-59,≥60 was divided into the young and middle-aged group（n=23）,the middle-aged and elderly group（n=77）,and the elderly group（n=116）.It was found that the BMI,SMI,and e GFR were the highest in the young and middle-aged group,while 25-（OH）-D₃was the lowest;The elderly group had the smallest SMI,e GFR,and TG,but higher creatinine levels than the middle-aged and elderly group;The prevalence of decreased skeletal muscle mass in the young,middle-aged,and elderly groups was 4.35%,16.88%,and 32.76%,respectively,with statistical significance（P<0.05）;Compared with the T2DM group without reduced skeletal muscle mass,the T2DM group with reduced skeletal muscle mass has a larger age,HOMA-IR,2h PBS,UACR,longer disease course,and smaller BMI,SMI,TG,and grip strength;Compared with the T2DM group without sarcopenia,the T2DM group with sarcopenia has a higher risk of developing CVD in terms of age,Hb A1c,2-hour PBS,and the next 10 years,with a longer course of disease,while BMI,SMI,and grip strength are smaller,all of which are statistically significant（P<0.05）;Among the common T2DM complications,the T2DM patients with decreased skeletal muscle mass combined with diabetes peripheral vascular disease accounted for the highest proportion,73.08%,with a statistically significant difference（P<0.05）.（3）BMI,SMI,decreased grip strength,course of disease,and age are related risk factors for skeletal muscle mass reduction in T2DM,with age,SMI,and decreased grip strength being independent risk factors;BMI,SMI,Hb A1c,decreased grip strength,course of disease,and age are related risk factors for the occurrence of sarcopenia in T2DM,with decreased grip strength being an independent risk factor（P<0.05）.（4）The occurrence of skeletal muscle mass reduction in T2DM was related to age（r=0.24,OR=1.04,P<0.05）,central obesity（r=-0.153,OR=0.50,P<0.05）,carotid atheromatous plaque（r=0.12,OR=3.63,P<0.05）,and hypertriglyceridemia（r=-0.16,OR=0.46,P<0.05）,but not gender,hypertension,and smoking.Conclusion:（1）The incidence of skeletal muscle mass reduction and sarcopenia in the T2DM group was significantly higher than that in the control group.Male T2DM is more significant,and the elderly T2DM group has the highest incidence of skeletal muscle mass reduction.（2）T2DM patients with reduced skeletal muscle mass have higher HOMA-IR and 2h PBS,and more severe insulin resistance in the body.T2DM patients with sarcopenia have higher Hb A1c and 2h PBS.（3）BMI,SMI,decreased grip strength,course of disease,and age are related risk factors for skeletal muscle mass reduction in T2DM,with age,SMI,and decreased grip strength being independent risk factors;BMI,SMI,Hb A1c,decreased grip strength,course of disease,and age are related risk factors for the occurrence of sarcopenia in T2DM,with decreased grip strength being an independent risk factor.（4）The highest proportion of T2DM with reduced skeletal muscle mass combined with peripheral vascular disease,which was related to age,central obesity,carotid atherosclerotic plaque,and hypertriglyceridemia in the risk factors of ASCVD.T2DM with sarcopenia has a higher risk of developing CVD in the next 10 years.