COMPARISON OF LOWER LIMB MUSCLE STRENGTH AND DISABILITY IN PATIENTS WITH TYPE 2 DIABETES

Abstract

The alteration of musculoskeletal system metabolism in patients with Type 2 Diabetes Mellitus (T2DM) affects lower limb strength, hindering their full participation in social and work activities requiring physical dexterity. This study evaluated differences in lower limb muscle strength and disability between T2DM patients under 60 years of age, comparing those with adequate or poor glycosylated hemoglobin (HbA1c) control. Sociodemographic characteristics (age, sex), clinical features (years with T2DM, comorbidities, HbA1c level, pharmacological treatment), and physical activity level were analyzed. Lower limb muscle strength was measured, and disability was determined for intergroup and intragroup comparison.

A comparative cross-sectional study was conducted with 61 patients aged 18-60 years, randomly selected from the Orthopedic Hospital. Participants were classified according to their HbA1c levels into controlled (<7%) and uncontrolled (≥7%) groups. Muscle strength was evaluated and classified using dynamometry, and disability was assessed using the WHODAS 2.0 scale. Statistical analysis included descriptive statistics for quantitative variables and group comparisons using Student's t-test or Mann-Whitney U test, depending on data distribution determined by the Kolmogorov-Smirnov test. For disability analysis, Chi-square or Fisher's tests were used as appropriate.

Regarding muscle strength, controlled group patients demonstrated greater strength in knee extension in both sexes (Women P=0.016; Men P=0.007). In women, a significant correlation was identified (Pearson correlation r=-0.57, P=0.01) between decreased knee extensor muscle strength and increasing age. Regarding disability, uncontrolled patients showed a significantly higher probability of experiencing moderate disability compared to controlled patients (OR=11.66).

Group comparison revealed significant differences in cognition (P=0.002), mobility (P=0.024), and social participation (P=0.021) domains. When analyzing by sex, women showed significant differences in mobility (P=0.05) and social relationships (P=0.02) domains, while men showed differences in cognition (P=0.01) and activities of daily living (P=0.04).

It is concluded that there are significant differences in knee extension muscle strength between controlled and uncontrolled T2DM patients under 60 years of age. The disability profile evaluated through WHODAS 2.0 showed significant differences between groups in cognition, mobility, and social participation domains. Sex-based analysis revealed that women present significant differences in mobility and social relationships, while men in cognition and activities of daily living. The results establish an association between "moderate" disability profile and HbA1c levels in T2DM patients, highlighting the importance of glycemic control in these patients' physical and social functionality.