Division of Endocrinology, Diabetes & Metabolism, Department of Medicine , The Johns Hopkins University , Baltimore, Maryland , USA.
University of Michigan , Ann Arbor, Michigan , USA.
BMJ Open Diabetes Res Care. 2015 May 4;3(1):e000086. doi: 10.1136/bmjdrc-2015-000086. eCollection 2015.
Persons with diabetes have accelerated muscle loss. The association of fasting and postchallenge glucose levels per se to grip strength, a clinical marker of poor physical function, and potential sex differences in this relationship has not been previously described.
Longitudinal cohort.
USA.
Participants were community-dwelling older adults (mean age 71.3 years) without self-reported diabetes and/or use of diabetes medication with glucose measured at baseline (1992-1996).
Fasting plasma glucose (FPG) was measured in 1019 women and 636 men. Two-hour glucose (2HG) levels after a 75 g oral glucose tolerance test were also available (women, n=870; men, n=559). Dominant hand grip strength was assessed using a hand-held dynamometer at 3.0±1.6 visits over a median 7.0 years. Mixed linear models examined the association of baseline glucose levels with grip strength, accounting for repeated visits, and adjusting for covariates.
Sex-specific FPG quartiles were associated with unadjusted differences in grip strength among women (p=0.03) but not men (p=0.50). However, in men, adjusting for age, education, height, weight, peripheral neuropathy, physical activity, and comorbidities, each SD (SD=17 mg/dL) higher FPG was associated with persistently lower grip strength (-0.44±0.22 kg, p=0.049); 2HG (SD=50 mg/dL) was unrelated to grip strength (-0.39±0.25 kg, p=0.13). In women, neither FPG (SD=16 mg/dL) nor 2HG (SD=45 mg/dL) was associated with grip strength (0.02±0.12 kg, p=0.90; and -0.20±0.14 kg, p=0.14; respectively) after adjustment. The rate of change in grip strength did not differ across FPG or 2HG quartiles in either sex.
In age-adjusted analyses, elevated fasting glucose levels are associated with persistently lower grip strength in older men, but not women. Future studies are needed to elucidate reasons for these sex differences and may provide further insight into accelerated loss of muscle function as a complication of diabetes in older adults.
糖尿病患者的肌肉流失速度加快。目前尚未有研究描述空腹和餐后血糖水平与握力（身体功能不佳的临床指标）之间的关系，以及这种关系是否存在潜在的性别差异。
纵向队列研究。
美国。
研究对象为居住在社区的老年人（平均年龄 71.3 岁），他们没有报告患有糖尿病，也没有使用降血糖药物，且在基线（1992-1996 年）时测量了血糖。
在 1019 名女性和 636 名男性中测量空腹血浆葡萄糖（FPG）。在口服葡萄糖耐量试验后 2 小时也可测量 2 小时血糖（2HG）水平（女性，n=870；男性，n=559）。使用手持测力计在中位数为 7.0 年的 3.0±1.6 次就诊中评估优势手握力。混合线性模型通过重复就诊，在调整了协变量的情况下，检验了基线血糖水平与握力之间的关系。
女性空腹血糖四分位数与未经调整的握力差异相关（p=0.03），但与男性无关（p=0.50）。然而，在男性中，校正年龄、教育程度、身高、体重、周围神经病变、身体活动和合并症后，每增加一个标准差（SD=17mg/dL）的 FPG 与持续较低的握力相关（-0.44±0.22kg，p=0.049）；2HG（SD=50mg/dL）与握力无关（-0.39±0.25kg，p=0.13）。在女性中，空腹血糖（SD=16mg/dL）和 2HG（SD=45mg/dL）都与握力无关（0.02±0.12kg，p=0.90；-0.20±0.14kg，p=0.14），且在调整后没有差异。在男性和女性中，握力的变化率在空腹血糖或 2HG 四分位数之间没有差异。
在年龄校正分析中，空腹高血糖与老年男性持续较低的握力有关，但与女性无关。需要进一步的研究来阐明这些性别差异的原因，并可能进一步深入了解糖尿病患者老年时肌肉功能加速丧失的机制。
