Skip Navigation
Skip to contents

Diabetes Metab J : Diabetes & Metabolism Journal

Search
OPEN ACCESS

Articles

Page Path
HOME > Diabetes Metab J > Volume 40(3); 2016 > Article
Response
Response: Hyperglycemia Is Associated with Impaired Muscle Quality in Older Men with Diabetes: The Korean Longitudinal Study on Health and Aging (Diabetes Metab J 2016;40:140-6)
Ji Won Yoon1,2,3, Hak Chul Jang1,2orcid
Diabetes & Metabolism Journal 2016;40(3):250-251.
DOI: https://doi.org/10.4093/dmj.2016.40.3.250
Published online: June 20, 2016
  • 3,343 Views
  • 30 Download
  • 4 Crossref
  • 3 Scopus

1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

2Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

3Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Korea.

Corresponding author: Hak Chul Jang. Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea. janghak@snu.ac.kr

Copyright © 2016 Korean Diabetes Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

We thank Dr. Moon for his comments in response to our study, "Hyperglycemia is associated with impaired muscle quality in older men with diabetes: The Korean Longitudinal Study on Health and Aging" [1].
The definition of muscle quality is still incompletely established, with various definitions such as: muscle strength per unit muscle mass/cross sectional area (CSA) [23], the degree of intramuscular or intermuscular adipose tissue [45], muscle fiber type change [6], or histological changes (including myofibrosis and myosteatosis) [7]. Even though it has not reached a consensus yet, muscle strength per muscle mass/area has been widely used as a definition of functional muscle quality in previous studies [2389]. As Dr. Moon mentioned, since intramuscular or intermuscular adipose tissue is associated with decreased muscle strength as well as insulin resistance [101112], it is possible that the relationship between severe hyperglycemia and muscle quality impairment is not a cause and effect. Therefore, we performed further analyses in order to evaluate the relationships between muscular fat, insulin resistance, blood glucose level and muscle quality using data from 217 subjects who took a mid-thigh computed tomography scan. The mid-thigh fat (perimuscular subcutaneous fat+intermuscular fat) CSA, not intermuscular fat area or intramuscular fat, was the only measurement available. The mid-thigh muscle-to-fat CSA ratio showed a significant negative correlation with HOMA-IR (r=–0.169, P=0.013), but did not have a significant relationship with fasting blood glucose or glycosylated hemoglobin (HbA1c; r=0.066, P=0.332; r=–0.025, P=0.713, respectively). Moreover, there was no significant association between the mid-thigh muscle-fat ratio and muscle quality (r=0.004, P=0.954). With these results, it is less likely that intermuscular fat confounded the relationship between hyperglycemia and poor muscle quality in our study.
As pointed out by Dr. Moon, diabetic complications may contribute to the deterioration of muscle quality. Unfortunately, diabetic complications like peripheral artery disease and diabetic neuropathy were not evaluated in our study participants, and therefore the effects of these conditions could not be excluded. However, we investigated the history of angina pectoris and myocardial infarction, which could reflect the macrovascular complication status. Among the subjects with a history of myocardial infarction or angina pectoris, one (4.8%) was in HbA1c <6.5% group, three (9.7%) were in 6.5% ≤HbA1c <7.5% group, but no one was in 7.5% ≤ HbA1c<8.5% or HbA1c ≥8.5% group, in which the differences in prevalence were statistically insignificant. Subjects with a history of cerebrovascular disease were excluded from the analysis. Also, diabetic complications tend to increase with duration of the disease. According to an analysis of variance analysis, the duration of diabetes significantly differed among the groups with different glycemic control status; however, in the post-hoc analysis, the duration of diabetes mellitus in the subjects with HbA1c ≥8.5% (mean±standard deviation, 110±112 months) was not significantly different compared with that in the subjects with 6.5%≤HbA1c<7.5% (111±120 months) and 7.5%≤HbA1c<8.5% (171±199 months). Therefore, confounding by diabetic complication status is possible but may not be serious in our study.
Also, we hope a future study will demonstrate the clinical consequences of muscle quality impairment in the near future. We appreciate Dr. Moon for the valuable comments and suggestions.

CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.

  • 1. Yoon JW, Ha YC, Kim KM, Moon JH, Choi SH, Lim S, Park YJ, Lim JY, Kim KW, Park KS, Jang HC. Hyperglycemia is associated with impaired muscle quality in older men with diabetes: The Korean Longitudinal Study on Health and Aging. Diabetes Metab J 2016;40:140-146. ArticlePubMedPMCPDF
  • 2. Park SW, Goodpaster BH, Strotmeyer ES, de Rekeneire N, Harris TB, Schwartz AV, Tylavsky FA, Newman AB. Decreased muscle strength and quality in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes 2006;55:1813-1818. PubMed
  • 3. Kasai T, Ishiguro N, Matsui Y, Harada A, Takemura M, Yuki A, Kato Y, Otsuka R, Ando F, Shimokata H. Sex- and age-related differences in mid-thigh composition and muscle quality determined by computed tomography in middle-aged and elderly Japanese. Geriatr Gerontol Int 2015;15:700-706. PubMed
  • 4. Bang E, Tanabe K, Yokoyama N, Chijiki S, Kuno S. Relationship between thigh intermuscular adipose tissue accumulation and number of metabolic syndrome risk factors in middle-aged and older Japanese adults. Exp Gerontol 2016;79:26-30. ArticlePubMed
  • 5. Therkelsen KE, Pedley A, Hoffmann U, Fox CS, Murabito JM. Intramuscular fat and physical performance at the Framingham Heart Study. Age (Dordr) 2016;38:31ArticlePubMedPMCPDF
  • 6. van de Bool C, Gosker HR, van den Borst B, Op den Kamp CM, Slot IG, Schols AM. Muscle quality is more impaired in sarcopenic patients with chronic obstructive pulmonary disease. J Am Med Dir Assoc 2016;17:415-420. ArticlePubMed
  • 7. Zoico E, Corzato F, Bambace C, Rossi AP, Micciolo R, Cinti S, Harris TB, Zamboni M. Myosteatosis and myofibrosis: relationship with aging, inflammation and insulin resistance. Arch Gerontol Geriatr 2013;57:411-416. ArticlePubMedPMC
  • 8. Francis P, Toomey C, Mc Cormack W, Lyons M, Jakeman P. Measurement of maximal isometric torque and muscle quality of the knee extensors and flexors in healthy 50- to 70-year-old women. Clin Physiol Funct Imaging 2016 1 7 [Epub]. ArticlePDF
  • 9. Senechal M, Johannsen NM, Swift DL, Earnest CP, Lavie CJ, Blair SN, Church TS. Association between changes in muscle quality with exercise training and changes in cardiorespiratory fitness measures in individuals with type 2 diabetes mellitus: results from the HART-D study. PLoS One 2015;10:e0135057ArticlePubMedPMC
  • 10. Brumbaugh DE, Crume TL, Nadeau K, Scherzinger A, Dabelea D. Intramyocellular lipid is associated with visceral adiposity, markers of insulin resistance, and cardiovascular risk in prepubertal children: the EPOCH study. J Clin Endocrinol Metab 2012;97:E1099-E1105. ArticlePubMedPMC
  • 11. Ryan AS, Buscemi A, Forrester L, Hafer-Macko CE, Ivey FM. Atrophy and intramuscular fat in specific muscles of the thigh: associated weakness and hyperinsulinemia in stroke survivors. Neurorehabil Neural Repair 2011;25:865-872. ArticlePubMedPMCPDF
  • 12. Rahemi H, Nigam N, Wakeling JM. The effect of intramuscular fat on skeletal muscle mechanics: implications for the elderly and obese. J R Soc Interface 2015;12:20150365ArticlePubMedPMCPDF

Figure & Data

References

    Citations

    Citations to this article as recorded by  
    • Muscle Quality in Older Adults: A Scoping Review
      Charles Phillipe de Lucena Alves, Samuel Brito de Almeida, Danielle Pessoa Lima, Pedro Braga Neto, Ana Lúcia Miranda, Todd Manini, Lara Vlietstra, Debra L. Waters, Renata Moraes Bielemann, Rosaly Correa-de-Araujo, Ana Paula Fayh, Eduardo Caldas Costa
      Journal of the American Medical Directors Association.2023; 24(4): 462.     CrossRef
    • Neuromuscular dysfunction and exercise training in people with diabetic peripheral neuropathy: A narrative review
      Giorgio Orlando, Stefano Balducci, Andrew J.M. Boulton, Hans Degens, Neil D. Reeves
      Diabetes Research and Clinical Practice.2022; 183: 109183.     CrossRef
    • DPP4 inhibitors as a potential therapeutic option for sarcopenia: A 6-month follow-up study in diabetic older patients
      Canberk Sencan, Fatma Sena Dost, Esra Ates Bulut, Ahmet Turan Isik
      Experimental Gerontology.2022; 164: 111832.     CrossRef
    • Níveis glicêmicos e sarcopenia em idosos com diabetes mellitus do tipo 2
      Isabella Stoeterau, Deise Regina Baptista, Andrea Pires Muller, Juliana Ceronato, Magda Rosa Ramos da Cruz, Carla Viana Dendasck
      Revista Científica Multidisciplinar Núcleo do Conhecimento.2022; : 53.     CrossRef

    • PubReader PubReader
    • Cite this Article
      Cite this Article
      export Copy Download
      Close
      Download Citation
      Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

      Format:
      • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
      • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
      Include:
      • Citation for the content below
      Response: Hyperglycemia Is Associated with Impaired Muscle Quality in Older Men with Diabetes: The Korean Longitudinal Study on Health and Aging (Diabetes Metab J 2016;40:140-6)
      Diabetes Metab J. 2016;40(3):250-251.   Published online June 20, 2016
      Close
    • XML DownloadXML Download
    Yoon JW, Jang HC. Response: Hyperglycemia Is Associated with Impaired Muscle Quality in Older Men with Diabetes: The Korean Longitudinal Study on Health and Aging (Diabetes Metab J 2016;40:140-6). Diabetes Metab J. 2016;40(3):250-251.
    DOI: https://doi.org/10.4093/dmj.2016.40.3.250.

    Diabetes Metab J : Diabetes & Metabolism Journal
    Close layer