Nomura T1, Kawae T2, Kataoka H3, Ikeda Y4
1Kansai University of Welfare Sciences, Department of Rehabilitation Sciences, Osaka, Japan, 2Hiroshima University Hospital, Division of Rehabilitation, Hiroshima, Japan, 3KKR Takamatsu Hospital, Rehabilitation Center, Kagawa, Japan, 4Kochi Memorial Hospital, Diabetes Center, Kochi, Japan
Background: Diabetes is a risk factor for muscle weakness, and cross-sectional studies have shown that complications from diabetic neuropathy (DN) and disease severity lead to more prominent muscle weakness. In addition, in a longitudinal study of elderly patients, diabetes was shown to be a risk factor in accelerating muscle weakness due to age. However, whether or not DN further promotes age-related muscle weakness in elderly diabetic patients has not been clarified.
Purpose: To clarify the effects of DN on age-related muscle weakness in elderly type 2 diabetic patients through a longitudinal study.
Methods: Of the type 2 diabetic patients who participated in the Multicenter Survey of the Isometric Lower-Extremity Strength in Type 2 Diabetes (MUSCLE-std) study that we conducted from April 2010 to March 2015, 26 male and 20 female patients over 60 years old were recruited for the longitudinal study. Patients were judged to have DN complications if they had at least two or more of bilateral diminished or absent Achilles tendon reflex, bilateral decreased vibratory sensation in the medial malleoli, and complained of bilateral sensory symptoms in the feet. Lower extremity muscle strength was determined as isometric maximal knee extension force (KEF), using the weight ratio (Nm / kg) obtained by dividing torque (Nm) by body weight (kg). KEF from the baseline was measured until the follow-up (average 3.4 years after baseline) and were compared in the two groups with and without DN.
Results: There were 15 male and 11 female patients with DN, and there was no significant difference in the presence rate of DN according to gender. In addition, the age at baseline, BMI, HbA1c, and percentage of those with regular exercise habits were 69.5±5.6 years，24.2±5.1 kg/m2，9.9±2.1%，and 44.4%, respectively, for the group without DN, and 72.0±6.4 years，24.0±3.7 kg/m2，9.1±1.5%，and 32.1% for the group with DN. There were no significant differences in both groups. KEF at the baseline was 1.6±0.4 Nm/kg for the group without DN and 1.3±0.3 Nm/kg for the group with DN. It was significantly lower in the group with DN. From baseline to follow-up, there was a significant decrease in KEF in both groups. The rate of decrease in KEF was -2.9% on average in the group without DN, and -4.1% on average in the group with DN. Although the group with DN had a higher value, there were no significant differences between the two groups.
Conclusion(s): In elderly patients with type 2 diabetes, a significant decrease in KEF due to DN was observed. In addition, DN can possibly accelerate decline in KEF in elderly diabetic patients on the basis of aging.
Implications: Diabetic neuropathy in elderly patients with diabetes is a high-risk factor for lower extremity muscle weakness. For elderly diabetic patients with DN, progressive exercise therapy is necessary as a preventive long-term care measure.
Keywords: Diabetes, Muscle strength, Elderly patients
Funding acknowledgements: This work was supported by JSPS KAKENHI Grant Number JP15K01440, a research grant from the Kansai University of Welfare Sciences.
Purpose: To clarify the effects of DN on age-related muscle weakness in elderly type 2 diabetic patients through a longitudinal study.
Methods: Of the type 2 diabetic patients who participated in the Multicenter Survey of the Isometric Lower-Extremity Strength in Type 2 Diabetes (MUSCLE-std) study that we conducted from April 2010 to March 2015, 26 male and 20 female patients over 60 years old were recruited for the longitudinal study. Patients were judged to have DN complications if they had at least two or more of bilateral diminished or absent Achilles tendon reflex, bilateral decreased vibratory sensation in the medial malleoli, and complained of bilateral sensory symptoms in the feet. Lower extremity muscle strength was determined as isometric maximal knee extension force (KEF), using the weight ratio (Nm / kg) obtained by dividing torque (Nm) by body weight (kg). KEF from the baseline was measured until the follow-up (average 3.4 years after baseline) and were compared in the two groups with and without DN.
Results: There were 15 male and 11 female patients with DN, and there was no significant difference in the presence rate of DN according to gender. In addition, the age at baseline, BMI, HbA1c, and percentage of those with regular exercise habits were 69.5±5.6 years，24.2±5.1 kg/m2，9.9±2.1%，and 44.4%, respectively, for the group without DN, and 72.0±6.4 years，24.0±3.7 kg/m2，9.1±1.5%，and 32.1% for the group with DN. There were no significant differences in both groups. KEF at the baseline was 1.6±0.4 Nm/kg for the group without DN and 1.3±0.3 Nm/kg for the group with DN. It was significantly lower in the group with DN. From baseline to follow-up, there was a significant decrease in KEF in both groups. The rate of decrease in KEF was -2.9% on average in the group without DN, and -4.1% on average in the group with DN. Although the group with DN had a higher value, there were no significant differences between the two groups.
Conclusion(s): In elderly patients with type 2 diabetes, a significant decrease in KEF due to DN was observed. In addition, DN can possibly accelerate decline in KEF in elderly diabetic patients on the basis of aging.
Implications: Diabetic neuropathy in elderly patients with diabetes is a high-risk factor for lower extremity muscle weakness. For elderly diabetic patients with DN, progressive exercise therapy is necessary as a preventive long-term care measure.
Keywords: Diabetes, Muscle strength, Elderly patients
Funding acknowledgements: This work was supported by JSPS KAKENHI Grant Number JP15K01440, a research grant from the Kansai University of Welfare Sciences.
Topic: Non-communicable diseases (NCDs) & risk factors; Health promotion & wellbeing/healthy ageing; Primary health care
Ethics approval required: Yes
Institution: Kansai University of Welfare Sciences
Ethics committee: Institutional Review Board
Ethics number: 14-43
All authors, affiliations and abstracts have been published as submitted.
