While dual-energy X-ray absorptiometry (DXA) is useful for assessing the body composition, it is not widely employed because of its high cost, high radiation exposure, and the bulky equipment required. We investigated whether or not a bioelectrical impedance analysis (BIA) was a reliable method for diagnosing sarcopenia in patients with type 2 diabetes. In 188 hospitalized patients with type 2 diabetes, we compared the fat mass, lean body mass, and skeletal muscle index (SMI) assessed by DXA and a BIA. We also calculated the BIA cut-off values for the SMI corresponding to those determined by the Asian Working Group for Sarcopenia (AWGS) using DXA. A strong positive correlation between the 2 methods was observed for whole-body fat mass and lean body mass (ρ=0.94 and ρ=0.93, respectively). The cut-off value of the SMI for sarcopenia was 7.4 kg/m² in men and 5.7 kg/m² in women, being higher for men and the same for women than those values recommended by the AWGS (7.0 kg/m² and 5.7 kg/m², respectively). In conclusion, a BIA is also useful for diagnosing sarcopenia in patients with type 2 diabetes, although devices will need to be standardized in the future.

We retrospectively analyzed the CoDiC data from 39 institutes in the JDDM in order to clarify the progression of kidney dysfunction over 5 years and factors related to this progression among type 2 diabetes patients progressing to stage 4 diabetic nephropathy. The present study clarified that 1) about 1.7 times more patients recovered from the stage 4 to the stage 3 than those who remained in stage 4, 2) the estimated glomerular filtration rate (eGFR) in 37.4 % of patients who remained in stage 4 progressively declined with a mean rate of −3.6 mL/min/year over 5 years, while that in the rest of patients was maintained at roughly the starting value (initially 25.8; 5 years later 24.4 mL/min/1.73 m²). On comparing the patient profiles between the decliners and the non-decliners, a younger age, a low eGFR just before the study, a high systolic blood pressure and a high non-HDL cholesterol level were significantly associated with a severe decline (P<0.01). However, a propensity score matching analysis further clarified that the influence of these four risk factors on a severe decline was slight. These findings suggested that direct causes provoked the stage 4 by acute kidney injury were important for the kidney function prognosis, in addition to the genetic and pathological background characteristics of each patient.