The relationship between sarcopenia and pancreatic exocrine insufficiency in patients with tTYPE 2 diabetes mellitus

Introduction: Sarcopenia is an important geriatric syndrome that directly affects morbidity, mortality and quality of life. The prevalence of sarcopenia is higher in patients with Type 2 Diabetes mellitus (Type 2 DM). Increased insulin resistance and inflammation have been associated with sarcopenia in DM patients, those need more evidence. The relationship between DM and pancreatic exocrine insufficiency (PEI) is known, and few studies have shown the relationship between PEI and sarcopenia. In this study, we aimed to show a possible relationship between PEI and sarcopenia in old aged Type 2 DM patients. Material and methods: We included 120 old aged (≥65 years) Type 2 DM patients to this prospective study those admitted to Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine Outpatient Clinic, between May-December 2021. Characteristics of the patients, diseases and the complications were noted, malnutrition risk was screened with Mini-Nutritional Assessment-Short Form, PEY was screened with PEY test questionnaire, the hand grip strength was measured with a hand dynamometer, gait speed was evaluated with 4-meter walking test and muscle mass was measured with bioelectric impedance analysis (BIA). Fecal elastase test from stool sample was used to diagnose PEI. EWGSOP2 (European Working Group on Sarcopenia in Old People-2) criteria were used for the diagnosis of sarcopenia. We investigated whether there is a possible independent relationship between sarcopenia and PEY in old aged patients with type 2 DM. Results: Of 120 patients, 64.2% (n=77) were female and 35.8% (n=43) were male. Mean age was 70.4±4.2 years, mean BMI was 29.6±4.3 kg/m2. Malnutrition risk was observed in 15.8% (n=19) of the patients, obesity in 50.8% (n=61), low muscle strength in 59.1% (n=71) (53.4% in men, 62.3% in women) and low appendicular muscle mass index (ASMI) in 15% (n=18) (25.6% in men, 9.1% in women). According to the EWGSOP2 criteria, 10% of the patients (n=12, 7 men and 5 women) had definite sarcopenia. PEI was diagnosed in 22.5% (n=27) of the patients. Vitamin D deficiency showed significant association with probable sarcopenia in the whole group, whereas probable sarcopenia was associated with vitamin D deficiency in women and PEI in men. Muscle strength was significantly lower in patients with PEI in men (p=0.02). Although muscle mass was also lower in men with PEI, that difference did not showed statistical significance. Conclusion: Our results showed that PEI is associated with lower muscle strength in old aged Type 2 DM male patients. PEI should be investigated in old aged Type 2 DM patients with probable or definite sarcopenia. Further studies are needed. Key words: Type 2 Diabetes mellitus, sarcopenia, pancreatic exocrine insufficiency