Objective To develop a new, alternative sarcopenia risk score to screen for sarcopenia in type 2 diabetes patients in China and to demonstrate its validity. Research design and methods The data for this study came from a multicenter, cross-sectional study that had been designed to estimate the prevalence of sarcopenia among adults with type 2 diabetes and had been conducted in several hospitals in Beijing, China. A total of 1125 participants were randomly divided into two groups: an exploratory population and a validation population. A multivariable logistic regression model using the backward stepwise likelihood ratio method to estimate the probability of sarcopenia was fitted with candidate variables in the exploratory population. A new, alternative sarcopenia risk score was developed based on the multivariable model. The internal and external validations were performed in the exploratory and validation populations. The study was registered at Chinese Clinical Trial Registry (ChiCTR-EOC-15006901). Results The new, alternative sarcopenia risk score included five variables: age, gender, BMI, total energy intake per day, and the proportion of calories supplied by protein. The score ranged from − 2 to 19. The area under the receiver operating characteristic (ROC) curve of the risk score for the prediction of sarcopenia in type 2 diabetes patients was 0.806 (95% CI 0.741–0.872) and 0.836 (95% CI 0.781–0.892) in the exploratory and validation populations, respectively. At the optimal cutoff value of 12, the sensitivity and specificity of the score for the prediction of sarcopenia were 70.9% and 81.0% in the exploratory population and 53.7% and 88.8% in the validation population, respectively. The Hosmer–Lemeshow goodness-of-fit test showed a good calibration with the risk score in external validation ( χ 2 = 4.459, P = 0.813). Conclusions The new, alternative sarcopenia risk score appears to be an effective screening tool for identification of sarcopenia in Chinese patients with type 2 diabetes in clinical practice. Clinical trial registration Chinese Clinical Trial Registry, ChiCTR-EOC-15006901.

Background Exenatide is a glucagon-like peptide-1 receptor agonist that can reduce body weight. This study aimed to determine the efficacy of exenatide on body mass index (BMI) reduction in patients with type 2 diabetes mellitus (T2DM) with differing baseline body weight, blood glucose, and atherosclerotic status and to determine if there is a correlation between BMI reduction and cardiometabolic indices in these patients. Methods This retrospective cohort study used data from our randomized controlled trial. A total of 27 T2DM patients treated with combination therapy of exenatide twice daily and metformin for 52 weeks were included. The primary endpoint was a change in the BMI from the baseline to week 52. The secondary endpoint was a correlation between BMI reduction and cardiometabolic indices. Findings. The BMIs of overweight and obesity patients and those with glycated hemoglobin (HbA1c) ≥ 9% significantly decreased −1.42 ± 1.48 kg/m2(P=0.015) and −0.87 ± 0.93 kg/m2(P=0.003), respectively, at the baseline after 52 weeks of treatment. There was no reduction in BMI in patients with normal weight, HbA1c <9%, the nonatherosclerosis group, and the atherosclerosis group. The decrease in BMI was positively correlated with changes in blood glucose, high-sensitivity C-reactive protein (hsCRP), and systolic blood pressure (SBP). Conclusion BMI scores improved after exenatide treatment for 52 weeks in T2DM patients. Weight loss was affected by baseline body weight and blood glucose level. In addition, BMI reduction from the baseline to 52 weeks was positively correlated with baseline HbA1c, hsCRP, and SBP. Trial Registration. Chinese Clinical Trial Registry (ChiCTR-1800015658).

Sarcopenia is considered to be a new complication of type 2 diabetes (T2DM) leading to increased risk of adverse outcome. We performed a survey to evaluate glucose metabolism and nutritional status in sarcopenia patients with T2DM. Diabetic participants aged ≥50 years were grouped into a probable sarcopenia group with low muscle strength (n=405) and a nonsarcopenia group with normal muscle strength (n=720) according to the revised recommendations from EWGSOP2 (2018). Compared to the controls, the probable sarcopenia participants were older and had lower waist-to-hip ratio and BMI, longer diabetes duration, higher fasting plasma glucose level and glycosylated hemoglobin (HbA1c), decreased estimated glomerular filtration rate and lower bone mineral content, lower fatless upper arm circumference, lower appendicular skeletal muscle mass index (ASMI), and muscle quality in both genders. Multivariable logistic regression analysis showed increased age, male, low BMI, and increased HbA1c, combined with diabetic nephropathy and decreased serum albumin levels, were risk factors associated with low muscle strength in diabetes patients. In conclusion, diabetic patients with sarcopenia had worse glucose metabolism and nutritional status, decreased renal function and reduced muscle quality ,and muscle mass with a greater likelihood of osteoporosis, who need an overall health management to improve outcomes. This clinical trial registration is registered with the Chinese Clinical Trial Registry, ChiCTR-EOC-15006901.

Objective To investigate the prevalence of sarcopenia in middle aged and elderly patients with type 2 diabetes (T2DM) and clarify the associated risk factors. Methods From January 2016 to March 2018, 1125 T2DM patients over 50 years old in endocrinology departments of nine hospitals in Beijing were enrolled in this study with system random sampling method. All patients, including 586 males and 539 females, were grouped into middle aged group (50-59 years), young elderly group (60-74 years) and elderly group (over 75 years) by age. Body composition was measured with bioimpedance analysis. Low muscle mass was defined as the appendicular skeletal muscle mass index below 7.18 kg/m2 in men and 5.73 kg/m2 in women. Low muscle strength was defined as grip strength below 29.5 kg in men and 21.2 kg in women. Sarcopenia was defined with low muscle mass coexisted with low grip strength. Chi-square test was used to compare the prevalence difference between groups. Multivariate Logistic regression was used for correlation analysis. Results (1) The detection rate of low muscle mass in all participants was 14.0％(157/1125),which was significantly higher in male than that in female(18.3％vs 9.3％,χ2=18.867,P<0.05). (2) The detection rate of low grip strength in all participants was 36％(405/1125), which was significantly higher in male than that in female (50.3％ vs 20.4％,χ2=109.183, P<0.05). (3) The prevalence of sarcopenia in all participants was 8.5％(96/1125), which was significantly higher in male than that in female (12.8％vs 3.9％,χ2=28.509, P<0.05). The prevalence of sarcopenia were 4.4％(21/475), 8.9％(49/548), 25.5％(26/102) in middle aged group, young elderly group and elderly group, respectively (χ2=47.984, P<0.05). The sarcopenic prevalence in male was obviously higher than that in female in young elderly and elderly group (χ2=9.872-16.325, all P<0.05). (4) Logistic regression analysis showed that men, aging, low body mass index (BMI) and high glycated hemoglobin A1c (HbA1c) were risk factors associated with sarcopenia. The risk of sarcopenia increased obviously in patients older than 75 years (OR=4.992, 95％CI:2.448-10.179) or whose HbA1c was over 10％(OR=3.563, 95％CI:1.526-8.322). Conclusions The risk of low muscle mass and low muscle strength increases in aged and elderly patients with T2DM. Low BMI, aging, high HbA1c were risk factors associated with sarcopenia in elderly patients with T2DM.