الفهرس 
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Abstract
Despite having the highest prevalence of diabetes of any age group, older persons have often been excluded from clinical trials, although diabetes in older adults is linked to higher mortality, reduced functional status and increased risk of institutionalization.
Sarcopenia is a frequent syndrome in the elderly characterized by progressive and generalized loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life and death.
To date, there is no widely accepted definition of sarcopenia that is suitable for use in research and clinical practice.
Different studies have shown a close relationship between diabetes and sarcopenia. However, the pathogenesis of sarcopenia in diabetes remains a challenging concept, and multiple mechanisms including oxidative injury, mitochondrial dysfunction, subclinical inflammation, and insulin resistance have been proposed to be involved in acceleration of sarcopenia in diabetic patients.
Sarcopenia is an underdiagnosed entity, partly due to lack of consensus regarding the optimal approach to diagnosis.
The European Working group on Sarcopenia in Older People (EWGSOP) recommends using the presence of both low muscle mass and low muscle function (muscle strength or physical performance) for diagnosing sarcopenia.
The treatment of sarcopenia in diabetics requires a multifocal approach including combinations of resistance exercise with dietary supplements, hormone replacement, anti-inflammatory and other pharmacological treatment e.g. ACE inhibitors.
Our work was a comparative cross-sectional study to assess sarcopenia in diabetic and non-diabetic patients.
A total number of 260 elderly aged ≥ 65years were recruited to the study and divided into two equal groups, 130 of them were non diabetics (58 were male) and 130 were diabetics.
The diabetic group was subdivided according to HbA1C into controlled and uncontrolled groups:
a- Controlled diabetics (HbA1C≤7.5%): include 32 males and 33 females.
b- Uncontrolled diabetics (HbA1C>7.5%): include 31 males and 34 females.
All participants were informed about the aims and the procedures of the study and signed an informed consent form prior to beginning.
All subjects of this study were subjected to thorough full history intake (with assessment of nutrition by Mini Nutritional Assessment scale), general examination and anthropometric measurements (mid upper arm, mid calf and waist circumferences and body mass index).
Muscle mass was assessed by bioelectrical impedance analysis (BIA), muscle strength was assessed by hand grip strength (HGS) and physical performance was assessed by 4 meters walking speed test & The EWGSOP definition was used to diagnose sarcopenia.
All subjects of this study were also subjected to laboratory investigations including CBC, liver function tests, kidney functon tests, coagulation profile, fasting blood sugar, total cholesterol, triglycerides and HbA1C.
Our results showed that the prevalence of sarcopenia in the elderly diabetics and non-diabetics was 37.7 and 15.4%, respectively and was greater in both men and women with diabetes than in non- diabetic counterparts (38.1% vs 20.7% in men and 37.3% vs 11.1% in women).
As regards the impact of glycemic control on sarcopenia, our study revealed that the prevalence of sarcopenia in controlled diabetics was significantly lower than in uncontrolled diabetics (26.2 vs 49.2%).
Our study detected that sarcopenia increases with aging and with low body mass index.
Sarcopenia in our study was negatively correlated with serum albumin, hemoglobin and nutritional status.
As regards muscle mass in our study, it was significantly lower in diabetics than in non-diabetics (15.06 ± 2.20 vs 15.39 ± 1.66 kg/m2) and significantly lower in uncontrolled diabetics than in controlled diabetics (14.47 ± 2.17 vs 15.64 ± 2.1 kg/m2).
As regards muscle strength in our study, it was significantly lower in diabetics than in non-diabetics (18.83 ± 6.43 vs 26.61 ± 9.97 kg) but no significant difference in muscle strength was found between controlled diabetics and uncontrolled diabetics.
As regards gait speed in our study, older adults with type 2 diabetes were associated with slower walking than non-diabetics (0.74 ± 0.2 vs 0.96 ± 0.2 m/s). Moreover, gait speed was significantly lower in uncontrolled diabetics than in controlled diabetics (0.68 ± 0.2 vs 0.8 ± 0.17 m/s) and was inversely correlated with HbA1C (r= -0.273, p=0.002).
Our study revealed a positive correlaion between hemoglobin and each of muscle mass, muscle strength and physical performance.
We recommend good control of DM to help to improve the muscle function and/or delaying the occurrence of sarcopenia in diabetics.
Future studies on large number of elderly are recommended to assess the results of our study and to test the effects of various treatment modalities for sarcopenia.