BMJ Open Diab Res Care 2020;8:e001562. doi:10.1136/bmjdrc-2020-001562 Open access 1 Open access Applications of physical performance measures to routine diabetes care for frailty prevention concept: fundamental data with grip strength, gait speed, timed chair stand speed, standing balance, and knee extension strength Hiroki Yokoyama , 1 Toshihiko Shiraiwa, 2 Mitsuyoshi Takahara, 3 Masahiro Iwamoto, 4 Nobuichi Kuribayashi, 5 Takuo Nomura, 6 Minoru Yamada, 7 Hirohito Sone , 8 Shin-ichi Araki 9 For numbered affliations see end of article. Correspondence to Dr Hiroki Yokoyama; dryokoyama@yokoyamanaika. com To cite: Yokoyama H, Shiraiwa T, Takahara M, et al. Applications of physical performance measures to routine diabetes care for frailty prevention concept: fundamental data with grip strength, gait speed, timed chair stand speed, standing balance, and knee extension strength. BMJ Open Diab Res Care 2020;8:e001562. doi:10.1136/ bmjdrc-2020-001562 Received 14 May 2020 Revised 17 June 2020 Accepted 18 June 2020 Original research © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. ABSTRACT Introduction Progression of muscle strength weakening will lead to a poor physical performance and disability. While this is particularly important in patients with diabetes, the associations of reduced muscle strength measured by grip strength with clinical features and physical performance remain unclear. We investigated clinical features and physical performance measures in association with grip strength in elderly people with diabetes in a primary care setting. Research design and methods A cross-sectional study was conducted enrolling 634 male and 323 female Japanese patients with type 2 diabetes aged 60 years or older. First, grip strength was measured and the associations of gender-specifc grip strength with clinical features were evaluated. Second, in patients with a grip strength below the gender-specifc median, physical performance measures, including gait speed, timed chair stand speed, knee extension strength, standing balance, and short physical performance battery scores, were investigated. Patients with and without a low performance defned by Asian Working Group for Sarcopenia were compared in terms of clinical features and physical performance measures. Results Grip strength decreased according to aging and longer duration of diabetes and was independently related to body mass index, glycated hemoglobin A1c (HbA1c), serum albumin, albuminuria, neuropathy, and stroke in male patients, and to body mass index and albuminuria in female patients. The physical performance measures became worse proportionally to a decrease in the grip strength. Patients with a low performance exhibited a signifcantly older age, lower grip strength and serum albumin, higher albuminuria, and poorer physical performance measures than those without. Conclusions Reduced grip strength was associated with glycemic exposure indicators of age-related duration, HbA1c, and vascular complications. The physical performance measures became worse with decreasing grip strength. Measurements of grip strength and physical performance in patients with diabetes may help promote intervention to prevent frailty in future studies. Significance of this study What is already known about this subject? ► The number of elderly people with diabetes is in- creasing with the extension of life expectancy. Muscle strength weakening will progress with aging and lead to a low physical performance and to frailty. It is known that a decrease in muscle strength is ac- celerated by diabetes. However, the clinical features in association with muscle strength as measured by grip strength and physical performance measures remain unclear in the elderly people with diabetes. What are the new fndings? ► We revealed that reduced grip strength in elderly people with diabetes was associated with glycemic exposure indicators of age-related duration, glycat- ed hemoglobin A1c and vascular complications, and the physical performance measures became worse proportionally to a decrease in the grip strength. Patients with a low performance exhibited a sig- nifcantly older age, lower grip strength and serum albumin, higher albuminuria, and poorer physical performance measures than those without. How might these results change the focus of research or clinical practice? ► The measurements of grip strength and physical performance in patients with diabetes may help pro- mote intervention to prevent frailty in future studies. This study warrants the applications of the frailty concept to diabetes and applications of physical per- formance measures to the routine clinical practice. on March 2, 2022 by guest. Protected by copyright. http://drc.bmj.com/ BMJ Open Diab Res Care: first published as 10.1136/bmjdrc-2020-001562 on 18 September 2020. Downloaded from