Diabetic Sarcopenia. A proposed muscle screening protocol in people with diabetes : Expert document.

OBJECTIVES: To propose the grounds for "diabetic sarcopenia" as a new comorbidity of diabetes, and to establish a muscle screening algorithm proposal to facilitate its diagnosis and staging in clinical practice. METHOD: A qualitative expert opinion study was carried out using the nominal technique. A literature search was performed with the terms "screening" or "diagnostic criteria" and "muscle loss" or "sarcopenia" and "diabetes" that was sent to a multidisciplinary group of 7 experts who, in a face-to-face meeting, discussed various aspects of the screening algorithm. RESULTS: The hallmark of diabetic sarcopenia (DS) is muscle mass atrophy characteristic of people with diabetes mellitus (DM) in contrast to the histological and physiological normality of muscle mass. The target population to be screened was defined as patients with DM with a SARC-F questionnaire > 4, glycosylated haemoglobin (HbA1C) ≥ 8.0%, more than 5 years since onset of DM, taking sulfonylureas, glinides and sodium/glucose cotransporter inhibitors (SGLT2), as well as presence of chronic complications of diabetes or clinical suspicion of sarcopenia. Diagnosis was based on the presence of criteria of low muscle strength (probable sarcopenia) and low muscle mass (confirmed sarcopenia) using methods available in any clinical consultation room, such as dynamometry, the chair stand test, and Body Mass Index (BMI)-adjusted calf circumference. DS was classified into 4 stages: Stage I corresponds to sarcopenic patients with no other diabetes complication, and Stage II corresponds to patients with some type of involvement. Within Stage II are three sublevels (a, b and c). Stage IIa refers to individuals with sarcopenic diabetes and some diabetes-specific impairment, IIb to sarcopenia with functional impairment, and IIc to sarcopenia with diabetes complications and changes in function measured using standard tests Conclusion: Diabetic sarcopenia has a significant impact on function and quality of life in people with type 2 diabetes mellitus (T2DM), and it is important to give it the same attention as all other traditionally described complications of T2DM. This document aims to establish the foundation for protocolising the screening and diagnosis of diabetic sarcopenia in a manner that is simple and accessible for all levels of healthcare.

Different profiles of advanced heart failure among patients with and without diabetes mellitus. Findings from the EPICTER study.

AIM: This work aims to compare the characteristics of advanced heart failure (HF) in patients with and without type 2 diabetes mellitus (DM) and to determine the relevance of variables used to define advanced HF. PATIENTS AND METHODS: This cross-sectional, multicenter study included patients hospitalized for HF. They were classified into four groups according to presence/absence of advanced HF, determined based on general and cardiac criteria, and presence/absence of DM. To analyze the importance of variables, we grew a random forest algorithm (RF) based on mortality at six months. RESULTS: A total of 3153 patients were included. The prevalence of advanced HF among patients with DM was 24% compared to 23% among those without DM (p=0.53). Patients with advanced HF and DM had more comorbidity related to cardiovascular and renal diseases; their prognosis was the poorest (log-rank <0.0001) though the adjusted hazard ratio by group in the Cox regression analysis was not significant. The variables that were significantly related to mortality were the number of comorbidities (p=0.005) and systolic blood pressure (p=0.024). The RF showed that general criteria were more important for defining advanced HF than cardiac criteria. CONCLUSIONS: Patients with advanced HF and DM were characterized by DM in progression with macro and microvascular complications. The outcomes among advanced HF patients were poor; patients with advanced HF and DM had the poorest outcomes. General criteria were the most important to establish accurately a definition of advanced HF, being decisive the evidence of disease progression in patients with DM.

Lowering Blood Pressure with the Combination of a Sodium-Glucose Cotransporter 2 Inhibitor and a Glucagon-like Peptide-1 Receptor Agonist in Type 2 Diabetic Patients: A Clinical Evidence.

INTRODUCTION: Patients with type 2 diabetes mellitus (T2DM) often have numerous cardiovascular risk factors, among which hypertension. AIM: To evaluate the blood pressure variations among patients treated with a combination of a sodium-glucose cotransporter 2 inhibitor (iSGLT-2) and a glucagon-like peptide-1 receptor agonist (GLP-1ra). METHODS: We analyze 17 patients treated with this combination to quantify the changes on blood pressure by ambulatory blood pressure monitoring at baseline and at three and 6 months follow-up. RESULTS: We observed a decrease of HbA1c levels (p = 0.004) at six months follow-up, a decrease in mean 24 h systolic blood pressure [from 124 (11) mmHg to 123 (4.75) mmHg, p = 0.04] and in both, mean waking and sleeping systolic blood pressure, being greater the reduction in the sleeping time [118 (20) mmHg to 111 (20) mmHg, p = 0.004]. CONCLUSION: The effect of a combination therapy of an iSGLT-2 and a GLP-1ra on blood pressure in a real-world setting, may have summative effects especially in SBP.

High serum osmolarity at admission determines a worse outcome in patients with heart failure: Is a new target emerging?

AIMS: The osmolarity of human serum is restricted to a tightly regulated range, and any deviation has clinical implications. Our aim in this study was to establish whether differences in serum osmolarity in heart failure (HF) patients are related with a worse outcome. METHODS: We evaluated the prognostic value of serum osmolarity in patients with HF from the Spanish National Registry on Heart Failure (RICA), a multicenter, prospective registry that enrolls patients admitted for decompensated HF and follows them for 1year. Patients were divided into quartiles according to osmolarity levels. Primary endpoint was the combination of all-cause mortality and hospital readmissions for HF. RESULTS: A total of 2568 patients (47.46% men) were included. Patients with higher osmolarity were older, presented more comorbidities (especially diabetes mellitus and chronic kidney disease), and consequently had higher levels of glucose, urea, creatinine and potassium. During the 1-year follow-up, mortality among the quartiles was 18% (Q1), 18% (Q2), 23% (Q3) and 28% (Q4), p<0.001. After adjusting for baseline characteristics, high serum osmolarity was significantly associated with all-cause mortality (RR 1.02, 95% CI 1.01-1.03, p<0.001). We also found a significant increase in the combined endpoint of mortality and readmission among quartiles with higher osmolarity (p<0.001). Diabetes, eGFR, Barthel index, systolic blood pressure, body mass index, hemoglobin, NYHA class and beta-blocking agents were also independently associated with the primary endpoint. CONCLUSIONS: In patients admitted for decompensated HF, high serum osmolarity predicts a worse outcome, and is associated with a higher comorbidity burden, supporting its use as a candidate prognostic target in HF.