Physio-cognitive decline syndrome among middle-aged diabetes patients: Handgrip strength significantly correlates with glycaemic control and cognitive score.

Aims: To investigate the correlation between glycaemic control with component of Physio-Cognitive Decline Syndrome (PCDS) and among each component of PCDS itself. Methods: A cross sectional study was conducted (January 2021-November 2022) at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia on consecutively recruited T2DM outpatients aged 40-59 years old. Data on the latest three months HbA1c, hand grip strength (HGS), usual gait speed (GS), and Indonesian Montreal Cognitive Assessment (MoCA-Ina) were evaluated. Pearson or Spearman's test was used to analyse the correlations. Results: There were 133 subjects with median age 53 (40-59) years. The PCDS was found in 48.1 % subjects, of which 64.1 % with uncontrolled glycaemia. Significant correlations were found between HGS and HbA1c (r = -0.24, R2 = 0.06, p < 0.01) and MoCA-Ina score (r = 0.21, R2 = 0.04, p < 0.05). Conclusion: The higher HbA1c and the lower MoCA-Ina score, the weaker handgrip strength was.

Factors Associated with Sarcopenia in Maintenance Hemodialysis Patients: A Cross-Sectional Study.

BACKGROUND: Sarcopenia is associated with worse outcomes in maintenance hemodialysis (MHD) patients. Differences in criteria and methods used to diagnose sarcopenia, results in a wide range of prevalence. Factors associated with sarcopenia in MHD have not been well-studied. This study aimed to investigate the prevalence and factors associated with sarcopenia in the MHD population. METHODS: Observational cross-sectional study was done with 96 MHD patients aged ≥18 years old, with dialysis vintage ≥120 days at Cipto Mangunkusumo Hospital March-May 2022. Descriptive, bivariate, and logistic regression analysis were done to find sarcopenia's prevalence and association with Simplify Creatinine Index (SCI), type 2 diabetes (DM), Interleukin-6 (IL-6), nutritional status, physical activity, and phosphate serum level. Asian Working Group for Sarcopenia (AWGS) 2019 criteria used to diagnose sarcopenia, Hand Grip Strength (HGS) to identify muscle strength, Bioimpedance Spectroscopy (BIS) to calculate muscle mass, and 6-meter walk test to evaluate physical performance. RESULTS: The prevalence of sarcopenia was 54.2%. Factors with a significant association in bivariate analysis were phosphate serum level (p=0.008), SCI (p=0.005) and low physical activity (International Physical Activity Questionnaire) (p-0.006). Logistic regression analysis found higher phosphate serum level and high physical activity protective of sarcopenia (OR 0.677;CI95% 0.493-0.93 and OR 0.313;CI95% 0.130-0.755 respectively). CONCLUSION: The prevalence of sarcopenia in the MHD population was 54.2%. Phosphate serum level, SCI, and physical activity were significantly correlated with sarcopenia. Both high phosphate level and high physical activity were protective against sarcopenia.

Sarcopenia and Chronic Complications of Type 2 Diabetes Mellitus.

Sarcopenia, defined as the loss of skeletal muscle mass and strength and/or a decrease in physical performance, is classically related to aging. However, chronic disease, including type 2 diabetes mellitus (T2DM), may accelerate the development of sarcopenia. Previous studies found strong association between T2DM and sarcopenia. Insulin resistance that exists in T2DM is thought to be the key mediator for impaired physical function and mobility which may lead to sarcopenia. T2DM may cause sarcopenia through the mediation of insulin resistance, inflammation, accumulation of advanced glycation end-products, and oxidative stress that may affect muscle mass and strength, protein metabolism, and vascular and mitochondrial dysfunction. On the other hand, loss of muscle in sarcopenia may play a role in the development of T2DM through the decreased production of myokines that play a role in glucose and fat metabolism. This review highlights the findings of existing literature on the relationship between T2DM and sarcopenia which emphasize the pathophysiology, chronic vascular complications, and the course of macrovascular and microvascular complications in T2DM.

The role of digital mobile technology in elderly health management among health care workers in Indonesia: Analysis of knowledge, attitudes, and practice.

Background: Technology, including information and communication technology (ICT), plays a significant role in the quality of health services. However, its application in elderly health services is still lacking. The aim of this study was to determine the knowledge of, attitudes toward, and practices of cell phone and mobile application use for elderly health care among Indonesian health care workers. Methods: This was a cross-sectional study conducted with health care workers in Jakarta, Indonesia. The potential subjects were contacted through instant messenger application and/or through conventional short message service or telephone calls from August through November 2020. Results: There were 134 subjects. All the subjects had used various health applications to assist with their daily work, including telemedicine (64.2%), guidelines (60.4%), and medical calculators (46.3%). However, 96.3% of the subjects were not aware of the existence of a health application for geriatric assessment. Furthermore, 98.5% of subjects thought that it is important to use ICT to manage geriatric patients, and 94.8% felt that comprehensive geriatric assessment (CGA) in digital form would help them manage geriatric patients better. Nevertheless, 35.10% of subjects had never applied CGA to their geriatric patients. Conclusions: The current health care system has begun to enter a period of using ICT in performing health services for geriatric patients. Nevertheless, only a few Indonesian health care workers were aware of or were using the geriatric mobile application. It is essential to improve the dissemination of geriatric health care and e-health literacy among them to improve the quality of elderly health care.

The impact of low muscle function on health-related quality of life in Indonesian women with systemic lupus erythematosus.

OBJECTIVE: There was no study aimed at evaluating the effect of muscle function on SLE patients' quality of life using the Sarcopenia Quality of Life (SarQoL) questionnaire. METHODS: This cross-sectional study recruited 61 women with SLE consecutively, muscle function was measured with Jamar handheld-dynamometer and 6-meter walk test, HRQoL was measured with Sarcopenia Quality of Life (SarQoL) questionnaire. The cut-off point for low muscle strength (<18 kg) and low gait speed (<1.0 m/s) was according to the Asian Working Group on Sarcopenia 2019 criteria. Statistical analysis was conducted with a t-test for mean difference, and linear regression was used to adjust confounders (age, protein intake, physical exercise, and disease activity). RESULTS: The subjects' mean muscle strength was 19.54 kg (6.94), and 44.3% (n = 27) was found to have low muscle strength. The subjects' mean gait speed was 0.77 m/s (0.20), and 90.3% (n = 55) was found to have low gait speed. The difference of total SarQoL score in subjects with normal and low muscle strength was found to be significant; 74.86 (9.48) vs. 65.49 (15.51) (p = 0.009), and still statistically significant after adjustments with age, protein intake, physical exercise level, and disease activity [B 0.56; 95% CI 0.08-1.03; p = 0.022]. The difference of total SarQoL score in subjects with normal and low physical performance was found to be not significant, 70.67 (11.08) vs. 70.72 (13.56) (p = 0.993). CONCLUSION: There was a significant difference in SarQoL's total score in normal compared with low muscle strength groups of Indonesian women with SLE.

Diagnostic Performance of Calf Circumference, Thigh Circumference, and SARC-F Questionnaire to Identify Sarcopenia in Elderly Compared to Asian Working Group for Sarcopenia's Diagnostic Standard.

BACKGROUND: sarcopenia is one of many geriatric problems that may lead to major clinical outcomes. Calf and thigh circumference have good correlation with muscle mass, whereas SARC-F questionnaire is very predictive of muscle function. There has not been a study that evaluates the diagnostic performance of calf and thigh circumference in combination with SARC-F questionnaire in detecting sarcopenia. The aim of this study was to investigate the diagnostic performance of calf and thigh circumference in combination with SARC-F questionnaire compared to standard diagnostic methods of sarcopenia according to the Asian Working Group for Sarcopenia (AWGS) to predict sarcopenia in patient aged 60 years or older. METHODS: this cross-sectional study was conducted in Geriatric Clinic Cipto Mangunkusumo Hospital, Jakarta, Indonesia during April-June 2018. Analysis was performed using receiver operating characteristic (ROC) curve to determine the cut-off point as well as sensitivity (Sn), specificity (Sp), positive and negative predictive value (PPV and NPV), positive and negative likelihood ratio (LR+ and LR-) of calf and thigh circumference as an indicator of low muscle mass, and SARC-F questionnaire score to detect decreased muscle function. RESULTS: from 120 participants, there were 46 men (38.3%) and 74 women (61.7%). The combination of calf circumference with cut-off point below 34 cm in men and below 29 cm in women, thigh circumference below 49 cm in men and below 44 cm in women with SARC-F questionnaire score of ≥4 have Sn, Sp, PPV, NPV, LR+, and LR- of 15.79%; 99.01%; 75.00%; 86.21%; 15.95; and 0.85 respectively. CONCLUSION: combination of calf and thigh circumference with SARC-F questionnaire showed good diagnostic accuracy in predicting sarcopenia in elderly outpatients.

Frailty state among Indonesian elderly: prevalence, associated factors, and frailty state transition.

BACKGROUND: Information about frailty status and its transition is important to inform clinical decisions. Predicting frailty transition is beneficial for its prevention. While Indonesia is the 4th largest geriatric population in Asia, data about frailty transition is limited. This study aimed to obtain data on prevalence of frailty, its risk factors, frailty state transition and its prognostic factors, as well as to develop prognostic score for frailty state transition. METHODS: Multicenter study on subjects aged ≥60 years old was done to obtain the prevalence of frailty status and to identify risk factors of frailty. Prospective cohort over 12 months was done to obtain data on frailty state transition. Multiple logistic regression analysis was performed to identify its prognostic factors from several clinical data, which then were utilized to develop prognostic score for frailty state worsening. RESULTS: Cross-sectional data from 448 subjects showed that 25.2% of the subjects were frail based on Frailty index-40 items. Risk factors of frailty were age (OR 2.72; 95% CI 1.58-4.76), functional status (OR 2.89; 95% CI 1.79-4.67), and nutritional status (OR 3.75; 95% CI 2.29-6.13). Data from the 162 subjects who completed the cohort showed 27.2% of the cohort had frailty state worsening. Prognostic factors for frailty state worsening were being 70 years or older (OR 3.9; 95% CI 1.2-12.3, p < 0.05), negative QoL, i.e., fair and poor QoL (OR 2.5; 95% CI 1.1-5.9, p < 0.05), and slow gait speed (OR 2.8; 95% CI 1.3-6.4, p < 0.05). The internal validation of the prognostic score consisted of those three variables showed good performance. CONCLUSION: The prevalence of frailty in this study among Indonesian elderly in outpatient setting was 25.2%. The risk factors of frailty were age, functional status and nutritional status. The prognostic factors for frailty state worsening were being 70 years old or older, negative QoL (fair or poor quality of life), and slow gait speed. A prognostic score to predict frailty state worsening in 12 months had been developed.

Effect of Metformin on Handgrip Strength, Gait Speed, Myostatin Serum Level, and Health-related Quality of Life: A Double Blind Randomized Controlled Trial among Non-diabetic Pre-frail Elderly Patients.

BACKGROUND: sarcopenia contributes to the development of frailty syndrome. Frailty syndrome is potentially improved by modifying insulin resistance, inflammation, and myostatin level. This study is aimed to investigate the effect of metformin on handgrip strength, gait speed, myostatin serum level, and health-related quality of life (HR-QoL) among non-diabetic pre-frail elderly patients. METHODS: a double blind randomized controlled trial study was conducted on non-diabetic elderly outpatients aged ≥ 60 years with pre-frail status based on phenotype and/ or index criteria (Cardiovascular Health Study and/ or Frailty Index 40 items) consecutively recruited from March 2015 to June 2016 at Cipto Mangunkusumo Hospital. One-hundred-twenty subjects who met the research criteria were randomized and equally assigned into 3 x 500 mg metformin or placebo group. The study outcomes were measured at baseline and after 16 weeks of intervention. RESULTS: out of 120 subjects, 43 subjects in metformin group and 48 subjects in placebo group who completed the intervention. There was a significant improvement on the mean gait speed of metformin group by 0.39 (0.77) second or 0.13 (0.24) meter/second that remained significant after adjusting for important prognostic factors (p = 0.024). There was no significant difference on handgrip strength, myostatin serum level, and HR-QoL between both groups. CONCLUSION: 3 x 500 mg metformin for 16 weeks was statistically significant and clinically important in improving usual gait speed as one of the HR-QoL dimensions, but did not significantly improve the EQ-5D index score, handgrip strength, nor myostatin serum level.

Correlation between vitamin D concentration and basic functional mobility in elderly women.

AIM: to determine vitamin D serum concentration, the timed up and go (TUG) test score, and the correlation between vitamin D serum concentration and TUG test score of elderly women. METHODS: a correlative cross-sectional study of elderly women aged 60 years old or above was carried out in three nursing homes in DKI Jakarta and one elderly nursing home in Bekasi, in January 2005. TUG test was performed to evaluate basic functional mobility by measuring the time in seconds to stand from 46 cm height armchair, walk three meters, turn around, and return to full sitting in chair. Vitamin D serum concentration was measured by ELISA method. Calcium ion serum concentration that was measured by NOVA method, age and body mass index (BMI) were confounding variables. RESULTS: of forty-two elderly women who met the inclusion and exclusion criteria, thirty subjects which proportional randomly assigned participated in this study. Mean (+SD) vitamin D serum concentration was 68.0 (21.1) nmol/L, with concentration < 50 nmol/L was 23.3%, TUG score was 10.7 (2.1) seconds, BMI was 22.3 (3.7) kg/m2, age was 70.2 (6.4) years, and median (minimum-maximum) ionized calcium serum concentration was 1.095 (1.030-1.230) mmol/L. Vitamin D serum concentration did not show significant correlation with TUG (r = -0.008; P = 0.968). There were also no significant correlations among the confounding variables and TUG. The correlation with TUG for BMI r = 0.014; P = 0.942, ionized calcium serum concentration r = 0.287; P = 0.124, and age r = 0.315; P = 0.09. CONCLUSION: vitamin D serum concentration has not show significant correlation with basic functional mobility of elderly women, the higher vitamin D serum concentration was not followed by lesser time to perform TUG test; the proportion of subjects with TUG score < 10 seconds (freely mobile in functional mobility) were lesser in vitamin D deficiency respondents.