Top

Acta Diabetologica

Published in:

01-06-2017 | Original Article

The impact of type 1 diabetes and diabetic polyneuropathy on muscle strength and fatigability

Authors: Giorgio Orlando, Stefano Balducci, Ilenia Bazzucchi, Giuseppe Pugliese, Massimo Sacchetti

Published in: Acta Diabetologica | Issue 6/2017

Abstract

Aims

Although it is widely accepted that diabetic polyneuropathy (DPN) is linked to a marked decline in neuromuscular performance, information on the possible impact of type 1 diabetes (T1D) on muscle strength and fatigue remains unclear. The purpose of this study was to investigate the effects of T1D and DPN on strength and fatigability in knee extensor muscles.

Methods

Thirty-one T1D patients (T1D), 22 T1D patients with DPN (DPN) and 23 matched healthy control participants (C) were enrolled. Maximal voluntary contraction (MVC) and endurance time at an intensity level of 50% of the MVC were assessed at the knee extensor muscles with an isometric dynamometer. Clinical characteristics of diabetic patients were assessed by considering a wide range of vascular and neurological parameters.

Results

DPN group had lower knee extensor muscles strength than T1D (−19%) and the C group (−37.5%). T1D group was 22% weaker when compared to the C group. Lower body muscle fatigability of DPN group was 22 and 45.5% higher than T1D and C group, respectively. T1D group possessed a higher fatigability (29.4%) compared to C group. A correlation was found between motor and sensory nerve conduction velocity and muscle strength and fatigability.

Conclusions

Patients with T1D are characterised by both a higher fatigability and a lower muscle strength, which are aggravated by DPN. Our data suggest that factors other than nervous damage play a role in the pathogenesis of such defect.

Guariguata L, Whiting DR, Hambleton I et al (2014) Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract 103:137–149. doi:10.1016/j.diabres.2013.11.002 CrossRefPubMed

Said G (2007) Diabetic neuropathy—a review. Nat Clin Pract Neurol 3:331–340. doi:10.1038/ncpneuro0504 CrossRefPubMed

Vinik AI, Nevoret M-L, Casellini C, Parson H (2013) Diabetic neuropathy. Endocrinol Metab Clin North Am 42:747–787. doi:10.1016/j.ecl.2013.06.001 CrossRefPubMed

Balducci S, Sacchetti M, Orlando G et al (2014) Correlates of muscle strength in diabetes: the study on the assessment of determinants of muscle and bone strength abnormalities in diabetes (SAMBA). Nutr Metab Cardiovasc Dis 24:18–26. doi:10.1016/j.numecd.2013.04.010 CrossRefPubMed

Krause MP, Riddell MC, Hawke TJ (2011) Effects of type 1 diabetes mellitus on skeletal muscle: clinical observations and physiological mechanisms. Pediatr Diabetes 12:345–364. doi:10.1111/j.1399-5448.2010.00699.x CrossRefPubMed

Andersen H, Gjerstad MD, Jakobsen J (2004) Atrophy of foot muscles: a measure of diabetic neuropathy. Diabetes Care 27:2382–2385. doi:10.2337/diacare.27.10.2382 CrossRefPubMed

Andreassen CS, Jakobsen J, Ringgaard S et al (2009) Accelerated atrophy of lower leg and foot muscles-a follow-up study of long-term diabetic polyneuropathy using magnetic resonance imaging (MRI). Diabetologia 52:1182–1191. doi:10.1007/s00125-009-1320-0 CrossRefPubMed

Andersen H, Poulsen PL, Mogensen CE, Jakobsen J (1996) Isokinetic muscle strength in long-term IDDM patients in relation to diabetic complications. Diabetes 45:440–445CrossRefPubMed

Allen MD, Major B, Kimpinski K et al (2014) Skeletal muscle morphology and contractile function in relation to muscle denervation in diabetic neuropathy. J Appl Physiol 116:545–552. doi:10.1152/japplphysiol.01139.2013 CrossRefPubMed

10.

Andreassen CS, Jensen JM, Jakobsen J et al (2014) Striated muscle fiber size, composition, and capillary density in diabetes in relation to neuropathy and muscle strength. J Diabetes 6:462–471. doi:10.1111/1753-0407.12124 CrossRefPubMed

11.

Andersen H, Gadeberg PC, Brock B, Jakobsen J (1997) Muscular atrophy in diabetic neuropathy: a stereological magnetic resonance imaging study. Diabetologia 40:1062–1069. doi:10.1007/s001250050788 CrossRefPubMed

12.

Sacchetti MS, Balducci S, Bazzucchi I et al (2013) Neuromuscular dysfunction in diabetes: role of nerve impairment and training status. Med Sci Sports Exerc 45:52–59. doi:10.1249/MSS.0b013e318269f9bb CrossRefPubMed

13.

Almeida S, Riddell MC, Cafarelli E (2008) Slower conduction velocity and motor unit discharge frequency are associated with muscle fatigue during isometric exercise in type 1 diabetes mellitus. Muscle Nerve 37:231–240. doi:10.1002/mus.20919 CrossRefPubMed

14.

Andersen H (1998) Muscular endurance in long-term IDDM patients. Diabetes Care 21:604–609. doi:10.2337/diacare.21.4.604 CrossRefPubMed

15.

Tesfaye S, Boulton AJM, Dyck PJ et al (2010) Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care 33:2285–2293. doi:10.2337/dc10-1303 CrossRefPubMedPubMedCentral

16.

Ainsworth BE, Haskell WL, White MC et al (2000) Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32(suppl.):s498–s504

17.

Orlando G, Balducci S, Bazzucchi I et al (2016) Muscle fatigability in type 2 diabetes. Diabetes Metab Res Rev 64:319–322. doi:10.1002/dmrr.2821

18.

Sayer AA, Dennison EM, Syddall HE et al (2005) Type 2 diabetes, muscle strength, and impaired physical function: the tip of the iceberg? Diabetes Care 28:2541–2542. doi:10.2337/diacare.28.10.2541 CrossRefPubMed

19.

Ijzerman TH, Schaper NC, Melai T et al (2012) Lower extremity muscle strength is reduced in people with type 2 diabetes, with and without polyneuropathy, and is associated with impaired mobility and reduced quality of life. Diabetes Res Clin Pract 95:345–351. doi:10.1016/j.diabres.2011.10.026 CrossRefPubMed

20.

Schofield KL, Rehrer NJ, Perry TL et al (2012) Insulin and fiber type in the offspring of T2DM subjects with resistance training and detraining. Med Sci Sports Exerc 44:2331–2339. doi:10.1249/MSS.0b013e318268008f CrossRefPubMed

21.

Allen MD, Kimpinski K, Doherty TJ, Rice CL (2015) Decreased muscle endurance associated with diabetic neuropathy may be attributed partially to neuromuscular transmission failure. J Appl Physiol 118:1014–1022. doi:10.1152/japplphysiol.00441.2014 CrossRefPubMedPubMedCentral

22.

Orlando G, Balducci S, Bazzucchi I et al (2016) Neuromuscular dysfunction in type 2 diabetes: underlying mechanisms and effect of resistance training. Diabetes Metab Res Rev 32:40–50. doi:10.1002/dmrr.2658 CrossRefPubMed

23.

Andersen H (1998) Association of muscle strength and electrophysiological measures of reinnervation in diabetic neuropathy. Muscle Nerve 21(12):1647–1654. doi:10.1002/(SICI)1097-4598(199812)21:12<1647:AID-MUS4>3.0.CO;2-D CrossRefPubMed

24.

Allen MD, Kimpinski K, Doherty TJ, Rice CL (2014) Clinical neurophysiology length dependent loss of motor axons and altered motor unit properties in human diabetic polyneuropathy. Clin Neurophysiol 125:836–843. doi:10.1016/j.clinph.2013.09.037 CrossRefPubMed

25.

Hilton TN, Tuttle LJ, Bohnert KL et al (2008) Excessive adipose tissue infiltration in skeletal muscle in individuals with obesity, diabetes mellitus, and peripheral neuropathy: association with performance and function. Phys Ther 88:1336–1344. doi:10.2522/ptj.20080079 CrossRefPubMedPubMedCentral

26.

Bittel DC, Bittel AJ, Tuttle LJ et al (2014) Adipose tissue content, muscle performance and physical function in obese adults with type 2 diabetes mellitus and peripheral neuropathy. J Diabetes Complicat 29:250–257. doi:10.1016/j.jdiacomp.2014.11.003 CrossRefPubMedPubMedCentral

27.

Ramamurthy B, Höök P, Jones AD, Larsson L (2001) Changes in myosin structure and function in response to glycation. FASEB J 15:2415–2422. doi:10.1096/fj.01-0183com CrossRefPubMed

28.

Ramamurthy B, Jones AD, Larsson L (2003) Glutathione reverses early effects of glycation on myosin function. Am J Physiol Cell Physiol 285:C419–C424. doi:10.1152/ajpcell.00502.2002 CrossRefPubMed

29.

Ramamurthy B, Larsson L (2013) Detection of an aging-related increase in advanced glycation end products in fast- and slow-twitch skeletal muscles in the rat. Biogerontology 14:293–301. doi:10.1007/s10522-013-9430-y CrossRefPubMed

30.

Coleman SK, Rebalka IA, Souza DMD et al (2015) Skeletal muscle as a therapeutic target for delaying type 1 diabetic complications. World J Diabetes 6:1323–1336. doi:10.4239/wjd.v6.i17.1323 CrossRefPubMedPubMedCentral

31.

Eshima H, Poole DC, Kano Y (2014) In vivo calcium regulation in diabetic skeletal muscle. Cell Calcium 56:381–389. doi:10.1016/j.ceca.2014.08.008 CrossRefPubMed

Title: The impact of type 1 diabetes and diabetic polyneuropathy on muscle strength and fatigability
Authors: Giorgio Orlando
Stefano Balducci
Ilenia Bazzucchi
Giuseppe Pugliese
Massimo Sacchetti
Publication date: 01-06-2017
Publisher: Springer Milan
Published in: Acta Diabetologica / Issue 6/2017
Print ISSN: 0940-5429
Electronic ISSN: 1432-5233
DOI: https://doi.org/10.1007/s00592-017-0979-9

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The impact of type 1 diabetes and diabetic polyneuropathy on muscle strength and fatigability

Abstract

Aims

Methods

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Aims

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2017

Determinants of glomerular filtration rate following bariatric surgery in individuals with severe, otherwise uncomplicated, obesity: an observational, prospective study

Bilateral lower limb edema induced by rapid improvement of glycemic control with insulin therapy in a subject with poorly controlled type 2 diabetes

Cause-specific mortality in a cohort of Brazilian patients with type 1 diabetes

The English National Screening Programme for diabetic retinopathy 2003–2016

Glucose-independent association of adiposity and diet composition with cardiovascular risk in children and adolescents with type 1 diabetes

Renal function preservation with pioglitazone or with basal insulin as an add-on therapy for patients with type 2 diabetes mellitus

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page