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Predisposition of Age-Related Muscle Loss Among Elderly With Type 2 Diabetes

Cross-sectional study conducted by SingHealth Polyclinics (SHP), in collaboration with Duke-NUS Medical School found 58 percent of older Type 2 Diabetes patients with pre-sarcopenia and sarcopenia.

Based on the statistics by the Ministry of Health, Singapore (MOH), in 2017 8.6 percent of Singaporeans aged 18 – 69 are diabetic. This number is projected to increase to amount to one million cases of diabetes by 2050.

In 2016, Singapore declared “The War on Diabetes” rallying a nation-wide effort to tackle diabetes and introduce initiatives in its prevention. Since then, the MOH has rolled out many programmes in the journey of addressing the prevalence of diabetes in Singapore. Coupled with Singapore’s rapidly ageing population there is a need to assess links between age-related conditions and chronic diseases such as diabetes.

The two-part study funded by Mitsui Sumitomo Insurance Welfare Foundation (MSIWF), found that within a study population of 387 elderly patients aged 60 to 89 years three fifths of them with Type 2 Diabetes are predisposed to pre-sarcopenia and sarcopenia.

Sarcopenia is an age-related condition characterised by loss of muscle mass and muscle function. This can result in other health and lifestyle complications for the elderly such as physical disability, frailty and fall risk. The loss of muscle mass is largely caused by ageing and is further aggravated by other contributing factors such as underlying inflammation, endocrine dysfunction, insulin resistance, nutritional deficit, and physical inactivity.

“Based on projections from the United Nations (UN), 47 percent of Singapore’s population will be aged 65 years or older in 2050. With this rapidly ageing population, the prevalence of sarcopenia is expected to rise. However, understanding the magnitude of sarcopenia and its associated mitigating factors, will help to prevent further deterioration of muscle strength and function from this disease,” said Adj A/Prof Tan Ngiap Chuan, Director of Research, SHP and Vice-chair, Research, SingHealth-Duke NUS Family Medicine Academic Clinical Programme (FM ACP).

Type 2 Diabetes patients from Pasir Ris Polyclinic were recruited and assessed for sarcopenia through three tests:

  1. Bio-electrical impedance analysis
  2. Handgrip strength using a dynamometer
  3. Six-meter gait speed based on the measurement of the average time taken for the patient to walk along a straight distance of six meters.

Sarcopenia was then diagnosed from the results according to the Asian Work Group for Sarcopenia (AWGS) Criteria. The results demonstrated that from the study population of Type 2 diabetes patients aged 60 to 89, 27.4 percent of them had sarcopenia, 3.9 percent had severe sarcopenia, and 30.5 percent of them had pre-sarcopenia. The study also found sarcopenia to be significantly associated with advanced age, multiple morbidities, diabetic nephropathy, hip circumference, and the number of consultations at primary care clinics.

“Ageing and having multiple medical conditions are associated with higher risk of sarcopenia. On top of that, we found that those whose kidneys are affected by diabetes (diabetic nephropathy) have 2.5 times higher risk of sarcopenia.” said A/Prof Tan.

“Taking steps towards a balanced diet and having regular exercise will improve diabetic control and promote kidney health. Healthy kidneys prevent loss of proteins, which is necessary for optimal muscle health. Not forgetting to have regular exercise, both cardio and resistance exercises, as they are essential to keep your muscles functional and strong.” added A/Prof Tan.

Further evaluation of the longitudinal relationship between clinic visits and sarcopenia will be done and identification of associated risk factors through the present study will assist in allocation of healthcare resources catered for sarcopenia screening and management for older patients with Type 2 Diabetes. [APBN]