Department of General Practice, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China.
J Cachexia Sarcopenia Muscle. 2022 Apr;13(2):909-918. doi: 10.1002/jcsm.12905. Epub 2022 Jan 23.
Prediabetes progression is associated with increased mortality while its regression decreases it. It is unclear whether muscle strength is related to prediabetes progression or regression. This study investigated the associations of muscle strength, assessed by grip strength and chair-rising time, with prediabetes progression and regression based on the China Health and Retirement Longitudinal Study (CHARLS) enrolling middle-aged and older adults.
We included 2623 participants with prediabetes from CHARLS, who were followed up 4 years later with blood samples collected for measuring fasting plasma glucose and haemoglobin A1c. Grip strength (normalized by body weight) and chair-rising time were assessed at baseline and categorized into tertiles (low, middle, and high groups). Prediabetes at baseline and follow-up was defined primarily using the American Diabetes Association (ADA) criteria and secondarily using the World Health Organization (WHO) and International Expert Committee (IEC) criteria. Multinomial logistic regression analysis was applied to obtain the odds ratios (ORs) and 95% confidence intervals (CIs).
The mean age of included participants was 59.0 ± 8.6 years, and 46.6% of them were males. During follow-up, 1646 participants remained as prediabetes, 379 progressed to diabetes, and 598 regressed to normoglycaemia based on ADA criteria. Participants who progressed to diabetes had lower normalized grip strength than those who remained as prediabetes (0.49 ± 0.15 vs. 0.53 ± 0.15, P < 0.001), but participants who regressed to normoglycaemia showed the opposite (0.55 ± 0.16 vs. 0.53 ± 0.15, P = 0.003). However, chair-rising time was comparable across different groups (P = 0.17). Compared with participants in low normalized grip strength or high chair-rising time group, those in high normalized grip strength or low chair-rising time group had decreased odds of progression to diabetes (OR 0.62, 95% CI 0.44 to 0.87; and OR 0.69, 95% CI 0.51 to 0.93, respectively) after multivariable adjustment. However, both were unrelated to the odds of regression to normoglycaemia (OR 0.94, 95% CI 0.71 to 1.25; and OR 0.84, 95% CI 0.65 to 1.07, respectively). These outcomes remained generally comparable when prediabetes was defined by WHO or IEC criteria. Higher normalized grip strength but not lower chair-rising time was prospectively associated with lower blood pressure, better glycaemic condition, and lower inflammation (all P ≤ 0.04).
High muscle strength is associated with reduced odds of progression to diabetes but does not predict regression to normoglycaemia in prediabetes. Future studies are warranted to assess whether increases in muscle strength promote prediabetes regression.
前驱糖尿病的进展与死亡率的增加有关，而其缓解则降低了死亡率。肌肉力量与前驱糖尿病的进展或缓解是否相关尚不清楚。本研究基于中国健康与养老追踪调查（CHARLS），使用握力和起坐时间评估肌肉力量，探讨了肌肉力量与基于美国糖尿病协会（ADA）标准定义的前驱糖尿病进展和缓解的相关性。
我们纳入了 CHARLS 中 2623 名前驱糖尿病患者，他们在 4 年后接受了随访，采集了空腹血糖和糖化血红蛋白样本。在基线时评估了握力（按体重标准化）和起坐时间，并将其分为三分位数（低、中和高组）。基于 ADA 标准，主要采用美国糖尿病协会（ADA）标准，次要采用世界卫生组织（WHO）和国际专家委员会（IEC）标准来定义基线和随访时的前驱糖尿病。应用多变量逻辑回归分析获得比值比（OR）和 95%置信区间（CI）。
纳入研究的参与者平均年龄为 59.0±8.6 岁，其中 46.6%为男性。在随访期间，基于 ADA 标准，1646 名参与者仍为前驱糖尿病，379 名进展为糖尿病，598 名缓解为正常血糖。与仍为前驱糖尿病的参与者相比，进展为糖尿病的参与者的标准化握力较低（0.49±0.15 与 0.53±0.15，P<0.001），而缓解为正常血糖的参与者则相反（0.55±0.16 与 0.53±0.15，P=0.003）。然而，起坐时间在不同组之间无差异（P=0.17）。与低标准化握力或高起坐时间组相比，高标准化握力或低起坐时间组进展为糖尿病的可能性降低（OR 0.62，95%CI 0.44 至 0.87；和 OR 0.69，95%CI 0.51 至 0.93，分别）。然而，这两者与缓解为正常血糖的可能性均无关（OR 0.94，95%CI 0.71 至 1.25；和 OR 0.84，95%CI 0.65 至 1.07，分别）。当使用 WHO 或 IEC 标准定义前驱糖尿病时，这些结果总体上仍相似。较高的标准化握力但不是较低的起坐时间与较低的血压、更好的血糖状况和较低的炎症相关（均 P≤0.04）。
较高的肌肉力量与降低糖尿病进展的可能性相关，但与前驱糖尿病的缓解无关。未来的研究需要评估肌肉力量的增加是否能促进前驱糖尿病的缓解。
