Role of Ultrasound in the Evaluation of Skeletal Muscle Changes in Patients with Type 2 Diabetes Mellitus
Authors: Tahoun Omar Ahmed Mohammed , Mohamed Azza Abdel Ghafar Boraei , El Ela Mona Ahmed Abou 
Published: November 2024

Abstract

Background
Diabetes is a global public health problem, with type 2 diabetes mellitus (T2DM) accounting for more than 90% of the diabetic population and it has been consistently reported as one of the strongest correlates of mobility limitation, especially in older people, and a potential risk factor for future mobility disability and loss of independence. Long-term complications and diabetes-related comorbidities only partially explain the excess risk of disability associated with diabetes. Changes in body composition, in particular progressive loss of muscle mass and increase in fat mass, with decline in muscle strength and quality have been proposed as additional potential mediators of the association between diabetes and disability.

Aim of the Work
to investigate the differences in Skeletal muscle ultrasound features in people with and without type 2 diabetes mellitus.

Patients and Methods
This was a Case control study conducted at the Ultrasound Radiology Unit, Radiology Department, Ain Shams University Hospitals from July, 2023 to January 2024. The study was performed on simple random sample consists of 36 T2DM patients on regular follow up in the endocrinology clinics in Ain Shams University Hospitals. And 36 Healthy controls came for routine checkup in Ain Shams University Hospitals clinics and meeting the study inclusion criteria. A signed informed consent was obtained from all patients and controls prior to inclusion in the study after explaining the procedure details. The approval of research ethical committee of faculty of Medicine - Ain Shams University was obtained before starting the study. The privacy of participants and confidentiality of data was guaranteed during the various phases of the study.

Results
we measured three ultrasonic parameters. MT, FL and PA. The FL and PA are measured in both relaxed and contracted states. the DPN group had the lowest MT, FL at both rest and contracted states and PA at contracted state as well as the lowest ΔFL and ΔPA. The control group had the highest MT, FL at both rest and contracted states and PA at contracted state as well as the highest ΔFL and ΔPA. The non-DPN group had intermediate values for the same variables. The differences among the groups were statistically significant for all the variables except for the pennation angle at rest. It showed that the ΔFL of the DPN group was significantly lower than that of the non-DPN group (p &lt; 0.001), which was similar to a previous conclusion that the gastrocnemius fascicles undergo the smallest length changes in a DPN group.

Conclusion
The combination of MT,ΔFL and ΔPA of the MG showed high-diagnostic accuracy (sensitivity &gt;80%; specificity &gt;95%) for predicting DPN, which could be used for rapid screening in the future. Early muscle ultrasound screening should be timely carried out in patients with T2DM, especially those with a long disease course and poor long-term blood glucose levels, and there is no difference between men and women.