Sarcopenia in postmenopausal patients with type 1 diabetes mellitus: characteristics of functional, laboratory, and instrumental indicators

BACKGROUND. Patients with type 1 diabetes mellitus (T1DM) are prone to earlier development of sarcopenia due to insulin deficiency, hyperglycemia, oxidative stress, and mitochondrial dysfunction. A pressing challenge in the  management of these patients is the search for standardized diagnostic tools for the timely detection and monitoring of sarcopenia.

OBJECTIVE. Comparative assessment of laboratory serum myokine levels in relation to muscle mass, strength, and function in postmenopausal women with type 1 diabetes and controls without diabetes.

MATERIALS AND METHODS. A single-center, cross-sectional comparative study was conducted in women with type 1 diabetes (n=40) and a control group (n=40) aged 50–75 years. The SARC-F questionnaire, laboratory parameters (myostatin, follistatin, cystatin C, lipocalin 2, IGF-1), muscle mass (iDXA densitometry), strength (wrist dynamometry), and function (short-form exercise battery) were assessed. Statistical processing was performed in Statistica 14.0.0.15, IBM SPSS Statistics 23 using the Mann-Whitney, Fisher, and Spearman correlation tests.

RESULTS. The age of the patients was 60 [56;64] years in the T1DM group and 64 [60;66] years in the control group (p=0.029). Glycated hemoglobin (HbA_1c) in the T1DM group was 8.0% [7.6;9.3] with a diabetes duration of 26 [13;42] years. The myostatin level was significantly higher in T1DM 52.73 [46.45;58.26] mg/ml versus 21.46 [19.07;24.74] in the control (p < 0.001) and positively correlated with HbA_1c (r=0.544, p < 0.001), but not with muscle strength and mass. HbA1c negatively correlated with the time it took to get up from a chair 5 times. No differences were found in the levels of follistatin, lipocalin 2, cystatin C. Wrist dynamometry strength and walking speed were lower in the T1DM group with a tendency to statistical significance. The median IGF-1 was lower in diabetes (92.7 vs. 114.1 ng/ml, p=0.014) and positively correlated with muscle strength (r=0.472, p < 0.001). The sarcopenia index negatively correlated with muscle strength (r=-0.402, p=0.021) and positively with HbA_1c (r=0.514, p=0.035). Severe sarcopenia (according to EWGSOP2) was diagnosed in only one patient with T1DM, whose myostatin level did not differ from the range of patients without sarcopenia.

CONCLUSION. Thus, patients with type 1 diabetes have higher myostatin levels, which correlates with with the level of HbA_1c. Low functional capacity in patients with type 1 diabetes is associated with HbA_1c levels, but is not directly related to myostatin levels.

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