研究背景
第二型糖尿病的特徵是胰島素阻抗、慢性發炎、晚期糖基化終端產物累積與氧化壓力增加，這些特徵對於骨骼肌肉的健康都是負向的。肌少症被定義為與年齡相關的骨骼肌質量，力量與身體功能的衰退。骨骼肌是人體中最大的胰島素敏感組織，肌少症中的低肌肉質量可能減少葡萄糖處理能力。因此，糖尿病與肌少症呈現雙向關係，值得探討。老年人的骨骼肌與代謝疾病盛行率逐年增加。肌少症已被證明與功能衰退、失能，和死亡率有關。而且第二型糖尿病造成的併發症，如大小血管病變，神經病變，慢性腎衰竭與視網膜病變，也與老年人的失能與死亡率相關。有無糖尿病或肌少症者之長期追蹤臨床結果也值得探索。
研究動機
目前台灣少有鄉村社區老年人糖尿病與肌少症(含嚴重肌少症)盛行率的相關研究，更罕有糖尿病與肌少症後續造成老年人失能與死亡的長期追蹤結果。
研究目的
評估南臺灣鄉村社區的老年人有無糖尿病合併肌少症的相關盛行率與危險因子。
研究對象
本研究使用2012年南台灣田寮區以全社區抽樣方法，最終選取完成檢查之285名65歲以上的男性和264名女性(整體回覆率為50%)。
研究方法
利用生物電阻抗分析測量身體組成，骨骼肌質量則通過楊森方程式估計。透過標準流程收集個案之小腿圍、握力、5次椅子站坐測試、步行速度和簡易身體功能評估等數據並以剩餘檢體進行生化血液檢查獲得肌少症相關生物標記。糖尿病被定義為滿足以下，其中一個條件(1)空腹血糖(AC) >= 126 mg/dl或(2)糖化血色素(HbA1C) >= 6.5%或(3)自述病史患有糖尿病者。肌少症定義依據2019年亞洲肌少症工作組（AWGS）更新共識，共分為4組，包含無糖尿病無肌少症、無糖尿病有肌少症、有糖尿病無肌少症及有糖尿病有肌少症。
研究結果
在549名研究參與者中，69名（12.6%）被歸類為患有肌少症，其中11名患有糖尿病，58名沒有糖尿病。比較老年非糖尿病組 (58/420 = 13.8%) 與糖尿病組 (11/129 = 8.5%)，肌少症的盛行率，兩者不具統計學上的差異。多重邏輯迴歸模型顯示，肌少症與年齡（勝算比 [OR] 1.14，95% 信賴區間 [CI] 1.05-1.22）、體脂百分比（OR 1.60，95% CI 1.34-1.91）、身體質量指數（OR 0.25，95% CI 0.16-0.38）和迷你營養評估評分（<24）（OR 2.73，95% CI 1.07-7.00）有明顯相關。而且，血糖控制不佳，罹患肌少症的風險有所增加的趨勢(Reference:HbA1C < 5.7%， ≥5.7%- <7% OR 1.37，≥7%- <9% OR 2.29，≥9% OR 1.82)。然而，肌少症相關生物標記，如:肌肉生長抑制素蛋白和鳶尾素在肌少症和非肌少症之間以及糖尿病和非糖尿病之間無顯著差異。
結論
南臺灣鄉村社區老年人約十分之一，無論是否患有糖尿病，都面臨著肌少症的威脅。反觀，充足的營養和有效的血糖控制有可能成為降低老年人肌少症風險的關鍵因素。這些發現對老年健康管理和預防策略具有影響，特別是在鄉村地區。儘管肌肉相關的生物指標，在本研究未能發現有明確預測肌少症的差異，仍須未來進一步的研究以確認其價值。

Whether the diabetes mellitus (DM) is associated with the risk of sarcopenia is an emerging issue. This study examines the prevalence and associated risk factors of sarcopenia in elderly individuals with and without diabetes living in a rural community, addressing a critical gap in geriatric health studies. Through the comprehensive whole-community sampling methods, a total of 549 participants (285 ♂, 264 ♀) aged over 65 were randomly selected and thoroughly examined (response rate = 50%) in 2012 from the Tianliao District, southern Taiwan. The study utilized cross-sectional data, including detailed health questionnaires, anthropometric assessments, and biochemical tests. Sarcopenia and severe sarcopenia were defined according to the 2019 update consensus of the Asia Working Group for Sarcopenia (AWGS). Participants were categorized into the DM group based on either medical history, blood HbA1c levels (≥6.5%), or fasting glucose (≥126 mg/dl), while others as the non-DM group. Of the 549 study participants, 69 (12.6%) were classified as having sarcopenia, including 11 with diabetes and 58 without diabetes. The prevalence of sarcopenia was comparable in the elderly non-diabetic population (58/420 = 13.8%) compared to the diabetic group (11/129 = 8.5%). Multiple logistic regression models indicated a clear association of sarcopenia with Age, Body fat percentage, Body Mass Index, and Mini Nutritional Assessment score. There is a trend of sarcopenia along with the poor glycemic control. Sarcopenia-related biomarkers as Myostatin protein and Irisin had no apparent significant difference between sarcopenia and non-sarcopenia neither between diabetes nor non-diabetes. Adequate nutrition and effective glycemic control emerged as crucial factors in reducing the risk of sarcopenia in the elderly.

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