Diabetes, sarcopenia and chronic kidney disease; the Screening for CKD among Older People across Europe (SCOPE) study
Authors: Formiga Francesc , Moreno-González Rafael , Corsonello Andrea , Carlsson Axel , Ärnlöv Johan , Mattace-Raso Francesco , Kostka Tomasz , Weingart Christian , Roller-Wirnsberger Regina , Tap Lisanne , Guligowska Agnieszka , Sieber Cornel , Wirnsberger Gerhard , Artzi-Medvedik Rada , Yehoshua Ilan , Giuli Cinzia , Lattanzio Fabrizia , Corbella Xavier ,   SCOPE investigators, Formiga Francesc , Moreno-González Rafael , Corbella Xavier , Martínez Yurema , Polo Carolina , Cruzado Josep Maria , Corsonello Andrea , Bustacchini Silvia , Bolognini Silvia , D’Ascoli Paola , Moresi Raffaella , Stefano Giuseppina Di , Giammarchi Cinzia , Bonfigli Anna Rita , Galeazzi Roberta , Lenci Federica , Bella Stefano Della , Bordoni Enrico , Provinciali Mauro , Giacconi Robertina , Giuli Cinzia , Postacchini Demetrio , Garasto Sabrina , Cozza Annalisa , Firmani Romano , Nacciariti Moreno , Rosa Mirko Di , Fabbietti Paolo , Ärnlöv Johan , Carlsson Axel , Feldreich Tobias , Mattace-Raso Francesco , Tap Lisanne , Ziere Gijsbertus , Goudzwaard Jeannette , Kostka Tomasz , Guligowska Agnieszka , Kroc Łukasz , Sołtysik Bartłomiej K , Smyj Katarzyna , Fife Elizaveta , Kostka Joanna , Pigłowska Małgorzata , Wójcik Agnieszka , Chrząstek Zuzanna , Sosowska Natalia , Telążka Anna , Weingart Christian , Freiberger Ellen , Sieber Cornel , Wirnsberger Gerhard Hubert , Roller-Wirnsberger Regina Elisabeth , Herzog Carolin , Lindner Sonja , Artzi-Medvedik Rada , Melzer Yehudit , Clarfield Mark , Melzer Itshak , Yehoshua Ilan , Gregorio Pedro Gil , Martínez Sara Laínez , Alonso Monica González , Calvo Jose A. Herrero , Molina Fernando Tornero , Fuentes Lara Guardado , García Pamela Carrillo , Pérez María Mombiedro , Bernabei Roberto , Bula Christophe , Haller Hermann , Zoccali Carmine , Jager Kitty , Biesen Wim Van , Stevens Paul E. 
Published: March 2022

Abstract
Background
Sarcopenia may be more present in older adults with diabetes (DM). Accordingly, we evaluated the prevalence of sarcopenia and its associated risk factors among community-dwelling older adults with DM.

Methods
A cross-sectional analysis of older people living in the community was carried out. Participants (aged 75 years and more) came from an European multicenter prospective cohort (SCOPE study). Global geriatric assessment including short physical performance battery, handgrip strength test and bioelectrical impedance analysis was performed. Sarcopenia was defined by the updated criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). Estimated glomerular filtration rate (eGFR) was calculated using Berlin Initiative Study (BIS) to define the stages of chronic kidney disease (CKD). Previous known DM was defined as physician-diagnosed DM registered in the patient's medical record or the use of DM-related medications. Hemoglobin A1c levels and specific DM therapies administered were collected. Time elapsed from the first diagnosis of DM was not collected and, therefore, was not included in the analyses.

Results
A total of 1,420 subjects were evaluated with a median age of 79.0 (6.0) years, of which 804 (56.6%) were women and 615 (43.3%) men; 315 (22.2%) participants had prior DM diagnosis, with a median age of 80.0 (6.0), 146 (46.3%) were women. Using EWGSOP2 definition, 150 (10.6%) participants in the SCOPE study met diagnostic criteria for sarcopenia. Participants without diabetes had more often normal results in the 3 sarcopenia components than participants with diabetes [887 (80.31%) vs. 227 (72.1%), p = 0.002], highlighting higher percentages of severe sarcopenia in participants with diabetes [27 (8.6%) vs. 58 (5.2%), p = 0.028]. Confirmed or severe sarcopenia was detected in 41 (13%) participants with diabetes and 109 (9.8%) participants without diabetes (p = 0.108). According to BIS equation, sarcopenia was not significantly more prevalent in the more advanced stages of CKD (p = 0.845). In multivariate analyses, older age (odds ratios [OR], 1.17; 95% confidence interval [CI], 1.08–1.27), and lower body mass index (OR, 0.79; 95% CI, 0.71–0.89 were associated with the presence of sarcopenia.

Conclusions
One tenth of all older community-dwelling subjects have sarcopenia. Older age and being thinner, but not worse renal function, were associated with higher prevalence of sarcopenia in older older adults with diabetes.