Background: Recently, GLP-1 receptor agonists and SGLT2 inhibitors have been frequently used to reduce the risk of diabetic kidney disease (DKD). However, these therapies may cause anorexia, sarcopenia, and an increased fall-risk. Furthermore, sarcopenia frequently accompanies chronic renal disease. The following study describes a novel method of screening to identify patients at an increased fall-risk in type 2 diabetic patients with DKD.
Methods: The procedure was tested in type 2 diabetic outpatients at our hospital. We measured outpatient one-leg standing (OLS) times with eye open and the timed up and go test (TUG), which were fall-risk assessment tools. OLS times of less than 20 seconds or TUG score of more than 11 seconds were predictive of a greater fall-risk. Furthermore, we used the ten time sit to stand test (TTSST) and toe grip strength test (TGST), grip strength, skeletal muscle mass index (SMI), and evaluated diabetic neuropathy. We also analyzed their dietary surveys about Salt and protein intake. We planned a novel exercise program for patients with a high fall-risk. Result: A total of 247 cases (147 males; 100 females) were included in this study. The prevalence of patients with OLS times of less than 20 seconds was 45.3%. Interestingly, 56.6% of patients who scored less than 11 seconds on the TUG also scored less than 20 seconds on their OLS time. The OLS time was significantly associated with impaired renal function. In patients with short OLS times (OLS time<5 seconds) and those with normal OLS times (OLS time≥20), eGFR (ml/min/1.73 m2) was 45.3 and 64.1 respectively. Short OLS times were also significantly associated with TTSST, TGST, SMI and DPN. Salt and protein intake was 7.4 g/day and 50.5 g/day. We are currently analyzing the effects of the exercise program.
Conclusion: In summary, a patient’s OLS time, which can be quickly measured in the doctor’s office, was significantly shorter in type 2 diabetic patients with DKD, and was a useful screening procedure to predict fall-risk.
S. Ikejima: None. S. Kondo: None. T. Takahashi: None. M. Uema: None. J. Umezu: None. A. Hirai: None.