Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
PeerJ. 2023 Jul 20;11:e15761. doi: 10.7717/peerj.15761. eCollection 2023.
Short-term (2 weeks to 3 months) insulin intensive therapy using continuous subcutaneous insulin infusion (CSII) can improve islet beta cell function and prolong glycemic remission in patients with newly diagnosed type 2 diabetes mellitus (T2DM). However, the total daily insulin dose (TDD, IU/kg/d) required to achieve near-normoglycemic control with CSII still needs to be frequently adjusted based on blood glucose monitoring. Although real-time continuous glucose monitoring (rtCGM), which measures the interstitial fluid glucose concentration continuously without much difficulty, facilitates the adjustment of insulin dosage, its adoption in the T2DM population is strictly limited by insurance coverage and lack of awareness of rtCGM among clinicians. Thus, it is of clinical significance to identify easy-to-use parameters that may allow a more rapid and accurate prediction of TDD requirement. This study aimed to explore the association between hand grip strength (HGS) and TDD requirement in patients with T2DM receiving CSII therapy.
A total of 180 eligible patients with T2DM were enrolled in the study and divided into three groups based on their HGS: low (L), medium (M), and high (H). The TDD requirement was calculated on day 7 or 8 of CSII treatment. Anthropometric parameters, including HGS, skeletal muscle mass, skeletal muscle index (SMI) and 6-m gait speed, and laboratory data, were collected on the morning of the second day after admission, within the first 24 h of CSII therapy. These parameters were used to identify significant predictors of TDD requirement using Pearson or Spearman correlation test, and stepwise multiple regression analysis.
There were no significant differences in age, duration of T2DM, waist-to-hip ratio (WHR), body mass index (BMI), blood pressure, liver function, estimated glomerular filtration rate, triglyceride, total cholesterol, glycosylated hemoglobin A1c (HbA1c), homeostatic model assessment of insulin resistance (HOMA-IR), and homeostasis model assessment of beta cell function (HOMA-β) among the groups. The H group had higher body muscle mass-to-fat ratio (BMFR), skeletal muscle mass-to-fat ratio (SMFR), SMI, 6-m gait speed, and lower TDD requirement than the M and L groups. The HGS negatively correlated with TDD requirement (r = -0.33, < 0.001) after adjusting for sex, age, BMI, WHR, HbA1c, Ln (HOMA-β), Ln (HOMA-IR), Ln (BMFR), Ln (SMFR), SMI, and 6-m gait speed. Multivariate stepwise regression analysis indicated that HGS was an independent predictor of TDD requirement in patients with T2DM (β = -0.45, < 0 001).
Lower HGS is associated with an increased TDD requirement in T2DM patients. HGS may facilitate the prediction of TDD requirement in T2DM patients receiving CSII therapy.
短期（2 周至 3 个月）胰岛素强化治疗使用持续皮下胰岛素输注（CSII）可以改善新诊断的 2 型糖尿病（T2DM）患者的胰岛β细胞功能并延长血糖缓解期。然而，使用 CSII 实现接近正常血糖控制所需的总日剂量（TDD，IU/kg/d）仍需根据血糖监测频繁调整。尽管实时连续血糖监测（rtCGM）可以毫不费力地连续测量间质液葡萄糖浓度，从而方便胰岛素剂量的调整，但由于保险覆盖范围以及临床医生对 rtCGM 的认识不足，其在 T2DM 人群中的应用受到严格限制。因此，识别可能更快速准确预测 TDD 需求的易用参数具有重要的临床意义。本研究旨在探讨 2 型糖尿病患者 CSII 治疗期间握力（HGS）与 TDD 需求之间的关系。
共纳入 180 例符合条件的 T2DM 患者，并根据 HGS 将其分为三组：低（L）、中（M）和高（H）。CSII 治疗第 7 天或第 8 天计算 TDD 需求。入院第二天早晨和 CSII 治疗的头 24 小时内收集人体测量参数，包括 HGS、骨骼肌量、骨骼肌指数（SMI）和 6 米步行速度以及实验室数据。使用 Pearson 或 Spearman 相关检验以及逐步多元回归分析来确定 TDD 需求的显著预测因子。
三组间年龄、T2DM 病程、腰臀比（WHR）、体重指数（BMI）、血压、肝功能、估算肾小球滤过率、甘油三酯、总胆固醇、糖化血红蛋白 A1c（HbA1c）、稳态模型评估的胰岛素抵抗（HOMA-IR）和稳态模型评估的胰岛β细胞功能（HOMA-β）无显著差异。H 组的体肌肉质量脂肪比（BMFR）、骨骼肌质量脂肪比（SMFR）、SMI、6 米步行速度较高，TDD 需求较低。调整性别、年龄、BMI、WHR、HbA1c、Ln（HOMA-β）、Ln（HOMA-IR）、Ln（BMFR）、Ln（SMFR）、SMI 和 6 米步行速度后，HGS 与 TDD 需求呈负相关（r=-0.33， <0.001）。多元逐步回归分析表明，HGS 是 T2DM 患者 TDD 需求的独立预测因子（β=-0.45， <0.001）。
较低的 HGS 与 T2DM 患者 TDD 需求增加相关。HGS 可能有助于预测接受 CSII 治疗的 T2DM 患者的 TDD 需求。
