The frequency of sarcopenia among diabetes mellitus patients and the effect on the quality of life

INTRODUCTION and AIM: Diabetes mellitus is a chronic disease that requires lifelong follow-up and treatment, is accompanied by many comorbid diseases and complications, and imposes a social and financial burden on the person and their environment. Diabetic patients tend to have lower muscle mass and strength. In addition, the development of microvascular and macrovascular complications has also been associated with sarcopenia. Sarcopenia is thought to be one of the important factors reducing the quality of life of the patient. In this study, we aimed to evaluate the frequency of sarcopenia, the factors affecting sarcopenia, and their effects on quality of life in patients with diabetes mellitus. MATERIALS and METHODS: Ethics committee approval of the study was obtained from Ankara Yıldırım Beyazıt University Faculty of Medicine Clinical Research Ethics Committee. Our study included 362 patients with diabetes mellitus who applied to Ankara Atatürk City Hospital Internal Medicine outpatient clinics. Demographic characteristics, duration of diabetes, additional diseases, anti-diabetic treatments and durations, microvascular complications, laboratory parameters, physical measurements, walking speed, grip strength, bioelectrical impedance analysis results of the patients who accepted to participate in the study were recorded and SF-36 quality of life scale was applied in the company with the researcher. In statistical analyses, frequencies and percentages were given for qualitative data, while median and interquartile ranges were given for quantitative data because they did not show a normal distribution. "Kolmogorov Smirnov Test" or "Shapiro Wilk Test" was used to determine normally distributed data. "Chi-square Test" or "Fisher Exact Test" was used to compare categorical data. Univariate and multivariate regression analyses were applied to determine the total mental and physical health score and the factors affecting sarcopenia. RESULTS: The study involved 362 patients, 196 (54.1%) were women and 166 (45.9%) patients were male. 103 patients (28.5%) were in the 18-48 age range, and 158 (43.6%) were in the age range 49 to 58 and 101 (27.9%) had at least 59 years and older. 57 (15.7%) of the patients were single and 305 (84.3%) were married. While the diabetes duration of the patients was 6.38 years on average, there were 179 (49.4%) patients with diabetes duration less than 5 years and 183 (50.6%) patients with diabetes 5 years or more. In addition to diabetes mellitus, 249 (68.8%) of the patients included in the study had at least one comorbid disease. When the antidiabetic treatments of the patients were examined, there were 89 (24.6%) patients not receiving any antidiabetic treatment, 199 (55%) patients receiving only OAD treatment, 18 (5%) patients receiving only insulin treatment, and 56 (15.4%) patients receiving OAD + insulin treatment together. Of the microvascular complications, peripheral neuropathy developed in 160 (44.2%) patients, retinopathy in 63 (17.4%) patients, and nephropathy in 108 (29.8%) patients. While 295 (81.5%) of the patients included in the study were not sarcopenic, 67 (18.5%) were evaluated as sarcopenic. In the multivariate logistic regression analysis for the factors affecting sarcopenia, the use of sulfonylureas and the presence of comorbid disease were found to have a significant effect on the development of sarcopenia. The relationship between sarcopenic presence and severity and poor quality of life was statistically significant. The effects of variables such as demographic characteristics, duration of diabetes and comorbidities, treatments, microvascular complication status, physical and BIA measurements, laboratory values, on total mental health score (MCS), and total physical health score (PCS) were evaluated. As a result of multivariate regression analysis, the presence of sarcopenia and neuropathy, high HbA1c level, walking speed less than 0.8 m/sec were found to be significant in predicting low MCS scores. Presence of sarcopenia, working with body strength, long-term insulin use, high HbA1c level, walking speed less than 0.8 m/sec were found to be statistically significant in predicting low PCS scores. Female gender and presence of CKD were found to be borderline significant in predicting low PCS scores. In addition, ROC analysis was performed to determine the MCS and PCS cut-off values, which are quality of life scores in sarcopenic individuals with DM. As a result of the analysis, the cut-off values for total mental health score and total physical health score were determined as 54.63 and 51.56, respectively. CONCLUSION: In conclusion, in our study, we found that the prevalence of sarcopenia in diabetic patients was 18.5% and the factors that most affected the development of sarcopenia were the presence of comorbid diseases and the use of sulfonylureas. The factors affecting the low MCS score were the presence of sarcopenia, development of neuropathy, high HbA1c level, and walking speed ≤ of 0.8 m/sec. In addition, the factors affecting the low PCS score were the presence of sarcopenia, working with body strength, long-term insulin use, high HbA1c level, and walking speed ≤ of 0.8 m/s. Since one of the treatment goals of patients with diabetes mellitus is to improve the quality of life of patients, blood sugar regulation should be ensured and the development of complications should be prevented. At the same time, lifestyle changes, recommending exercise programs to increase muscle mass, and initiating an appropriate diet program are very important in preventing sarcopenia. Keywords: Diabetes Mellitus, Sarcopenia, Quality of Life, SF 36, MCS, PCS