Older patients of diabetes mellitus have low creatinine levels

Debarati Basu, Makaut WB

The relationship between diabetes mellitus and muscle loss influenced by aging is not known. A cross-sectional dataset obtained from the Yuport Medical Checkup Center Study was utilized as an indicator of muscle mass i.e. serum creatinine levels. It was used to analyze older people with diabetes and older people without diabetes. 6133 participants were sorted into three groups: early-elderly (65–69 years), middle-elderly (70–74 years), and late-elderly (≥ 75 years). The odds ratio (OR) using logistic regression was calculated in each group for evaluating the relation between diabetes and the lowest creatinine level. It was obtained as less than or equal to the 25 percentile of serum creatinine.

Serum creatinine levels among older people

Serum creatinine levels are proportional to aging i.e. serum creatinine levels increase with aging among the participants. This tendency was significantly observed in the non-diabetic group. Late-elderly people without diabetes have higher creatinine levels than those people with diabetes. In men, it was ORs 2.50 (95% CI 1.99–4.50) and in women 2.88 (95% CI 1.47–5.64). Thus with aging, people having diabetes have lower creatinine levels where the relation among diabetic status and groups were 0.01 in men and 0.05 in women, respectively. Therefore with aging, the serum creatinine levels decrease in people suffering from diabetes.

Aging is escorted with significant changes of the body which include a continuous decline of muscle mass, muscle strength, quality, lower glucose tolerance levels, and the higher tendency of chronic diseases. Globally there is a surge in the number of older people as a result the pervasiveness of diabetes is also expected to increase. Now taking example, the pervasiveness of diabetes among people aged ranging from 75-79 years will rise from 1.4% in 2019 to 20.5% in 2045.

Role of the World Health Organization

In 2016 the World Health Organization commenced a global strategy for aging. The important determinants of “active aging” were physical activity and an increase in muscle mass. These play a notable role in decreasing morbidity in later stages of life. Studies show that low creatinine levels are linked with a higher tendency of type 2 diabetes and other cardiometabolic diseases. Some studies show that non-diabetic people have higher muscle mass and strength than people with diabetes mellitus. The relationship between the status of diabetes and the level of skeletal muscle mass among people aged 75years or above is ambiguous due to the unavailability of data, Furthermore, it is unclear whether the association between diabetes and muscle loss is influenced by aging. The authentic information linking diabetes and aging is not available much.

Results

6133 participants were taken for study. The study showed the mean age of men was observed as 69.8years i.e. SD: 4.3 and for women, it was 69.4years i.e. SD: 3.8, where SD stands for standard deviation. The study was done by categorizing 6133 people among three age groups. The study shows 15% i.e. 438 men and 9.8% i.e. 315 women were diagnosed, diabetic. The pervasiveness of diabetic men was similar throughout age groups. But women showed notable differences across age groups such as 8.6%, 9.7%, and 17.2%, respectively. There was no change in the mean fasting plasma glucose (FPG) levels in men with aging. But for women, there was an increase in the levels of the mean fasting plasma glucose (FPG) with aging. There is a decrease in the Glomerular filtration rates with aging in the late elderly groups for both men and women. Creatinine levels increase with aging in the late elderly groups for both men and women.

Limitations

• The study is based on the participants who voluntarily participated and so were healthier than the general old populations. Moreover, it may have happened that many people with diabetes with renal failures may have died at a much earlier age. Thus it reduces the number of very old people with higher creatinine levels while increasing the number of those with lower creatinine levels.
• Creatinine levels are indirectly linked with the amount of body muscle when there is normal kidney functioning. This study excluded participants with high creatinine levels.
• The nature of this study is cross-sectional so the casualty and the pathway between diabetes mellitus and loss of muscle mass were not mentioned.
• The study does not include data regarding BMI and history of cardiometabolic disease, comorbidity, frailty, and cognitive dysfunction, lifestyle, physical exercise and smoking status, and concomitant medications.

Conclusion

The study utilizes an enormous cross-sectional set of data consisting of people aging 65years or older. The study indicates that people with diabetes mellitus have a higher tendency of lower creatinine levels which indirectly constitute the amount of muscle mass comparing to non-diabetic people. This tendency was more significant in the case of the late elderly groups than in the early aged groups. Aging thus enhances the interaction of diabetes and muscle loss.

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References:

1. Cruz-Jentoft, A. J., & Sayer, A. A. (2019). Sarcopenia. The Lancet, 393(10191), 2636–2646. https://doi.org/10.1016/S0140-6736(19)31138-9
2. Basu, R., Breda, E., Oberg, A. L., Powell, C. C., Dalla Man, C., Basu, A., Vittone, J. L., Klee, G. G., Arora, P., Jensen, M. D., Toffolo, G., Cobelli, C., & Rizza, R. A. (2003). Mechanisms of the age-associated deterioration in glucose tolerance: Contribution of alterations in insulin secretion, action, and clearance. Diabetes, 52(7), 1738–1748.

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