社区老年2型糖尿病患者合并肌肉减少症的影响因素分析

Influencing factors for comorbid sarcopenia in community-dwelling elderly patients with type 2 diabetes mellitus

目的 调查新疆乌鲁木齐市社区老年2型糖尿病(T2DM)患者合并肌肉减少症的影响因素,为未来制定个体化的切实可行的干预措施提供参考。方法 选取2022年5月至8月新疆乌鲁木齐市社区老年T2DM患者408例为研究对象,采用问卷调查患者一般资料及临床资料,并测定患者身体功能。依据纳入T2DM患者是否合并肌肉减少症分为肌肉减少症组和非肌肉减少症组。采用单因素和多因素二元logistic回归分析T2DM合并肌肉减少症患者的影响因素。采用SPSS 25.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、Mann-Whitney U检验及χ^(2)检验。结果 T2DM合并肌肉减少症发生率20.6%(84/408)。两组患者在年龄段、体质量指数(BMI)、文化程度、月收入、空腹血糖、餐后2 h血糖、糖尿病病程、静坐时间、睡眠时间等方面的分布比较,差异均有统计学意义(P<0.05);两组患者骨骼肌质量指数、基础代谢率、身体总水分、蛋白质、无机盐、骨骼肌含量、体脂肪、体脂百分比、右上肢脂肪量、右下肢脂肪量、左下肢脂肪量、左上肢肌肉量、右上肢肌肉量、左下肢肌肉量、右下肢肌肉量、握力(左、右)明显低于非肌肉减少症组(P<0.05);肌肉减少症组患者5次坐立试验、6 m步速等方面显著高于非肌肉减少症组患者(P<0.05)。多因素分析结果显示:BMI=18.5-<23.9 kg/m2(OR=0.201,95%CI 0.03~1.338)、BMI≥27.9 kg/m^(2)(OR=0.019,95%CI 0.002~0.208)、T2DM病程(OR=1.095,95%CI 1.025~1.171)、每日静坐时间(OR=1.704,95%CI 1.299~2.235)、睡眠时间(OR=0.682,95%CI 0.48~0.969)、餐后血糖(OR=1.261,95%CI 1.056~1.506)、6 m步速(OR=1.224,95%CI 1.072~1.398)、5次坐立试验(OR=1.377,95%CI 1.204~1.576)、右下肢肌肉量(OR=0.369,95%CI 0.253~0.583)均是老年T2DM伴肌肉减少症的影响因素(P<0.05)。结论 T2DM病程、餐后血糖、每日静坐时间、6 m步速、5次坐立试验、BMI增高、右下肢肌肉量、睡眠时间均与老年T2DM伴肌肉减少症密切相关。

Objective To investigate the influencing factors for comorbid sarcopenia in community-dwelling older patients with type 2 diabetes mellitus(T2DM)in order to provide a reference for developing individualized and practical interventions.Methods A total of 408 elderly T2DM patients subjected by cluster sampling from the communities of Urumqi City,Xinjiang,were enrolled during May to August,2022.General data were collected through questionnaires,and clinical data and physical functions were measured and recorded.Univariate and multivariate binary logistic regression analyses were applied to identify the influencing factors for sarcopenia in T2DM patients.T2DM patients were divided into sarcopenia group and non-sarcopenia group.SPSS statistics 25.0 was used for statistical analysis.Student′s t test,Mann-Whitney U test or Chi-square test was utilized for intergroup comparison depending on data type.Results The incidence of sarcopenia was 20.6%(84/408)in the elderly T2DM patients.Significant differences were observed between those with sarcopenia and those without in terms of age,body mass index(BMI),education level,monthly income,fasting blood glucose(FBG),2-hour postprandial blood glucose,duration of diabetes mellitus,sedentary time,and sleep time(P<0.05).The sarcopenia group had obviously lower skeletal muscle mass index,basal metabolic rate,total body water amount,protein,inorganic salts,skeletal muscle content,and body fat,percentage of body fat,right upper limb fat mass,right lower limb fat mass,left lower limb fat mass,left upper limb muscle mass,right upper limb muscle mass,left lower limb muscle mass,right lower limb muscle mass,and grip strength(left and right)than the non-sarcopenia group(P<0.05).The sarcopenia group had statistically longer results in 5 times sit-to-stand test and 6-meter step speed test when compared with the non-sarcopenia group(P<0.05).Multivariate analysis showed that BMI 18.5-<23.9 kg/m^(2)(OR=0.201,95%CI 0.03-1.338),BMI≥27.9 kg/m 2(OR=0.019,95%CI 0.002-0.208),T2DM duration(OR=1.095,95%CI 1.025-1.171),daily sedentary time(OR=1.704,95%CI 1.299-2.235),sleep duration(OR=0.682,95%CI 0.48-0.969),postprandial blood glucose(OR=1.261,95%CI 1.056-1.506),6-meter step speed(OR=1.224,95%CI 1.072-1.398),result of five times sit-to-stand test(OR=1.377,95%CI 1.204-1.576),and right lower limb muscle mass(OR=0.369,95%CI 0.253-0.583)were all influencing factors for sarcopenia in elderly T2DM patients(P<0.05).Conclusion Duration of T2DM,postprandial blood glucose,daily sedentary time,6-meter step speed,result of five times sit-to-stand test,increased BMI,right lower extremity muscle mass,and sleep duration are strongly associated with sarcopenia occurrence in the elderly T2DM patients.