ASSESSMENT OF MUSCLE FUNCTION LOSS USING THE CREATININE-CYSTATIN C RATIO AND BODY FAT IN TYPE 2 DIABETES MELLITUS

Tran Ngoc Hien1, Tran Truong Trung Tinh1, Huynh Trung Quoc Hieu1, Mai Phuong Thao1, Le Quoc Tuan1
1 School of Medicine, University of Medicine and Pharmacy at Ho Chi Minh city

Main Article Content

Abstract

Objective: This study aims to evaluate the ability of the creatinin/cystatin C ratio in combination with percent body fat and age factor in predicting the decline of muscle mass and function in patients with type 2 diabetes mellitus.


Methods: A cross-sectional study of 93 patients with type 2 diabetes and 34 healthy controls recruited from the outpatient clinic of the University Medical Center Ho Chi Minh City - Campus 2. Appendicular skeletal muscle mass, appendicular skeletal muscle mass/body mass index, and percent body fat were measured using the InBody device. Muscle function was assessed using handgrip strength and walking time. Serum creatinine and cystatin C were used to calculate the creatinin/cystatin C ratio. Two predictive models were built: percent body fat + creatinin/cystatin C; and percent body fat + creatinin/cystatin C + age.


Results: Higher creatinin/cystatin C values were associated with greater appendicular skeletal muscle mass/body mass index, stronger handgrip strength, and shorter walking time. For detecting low muscle mass, AUC increased from 0.8 to 0.82. For weak muscle strength, AUC improved from 0.65 to 0.75, and for prolonged walking time, from 0.67 to 0.70 after adding age. The full model for the highest discrimination capability.


Conclusions: A combined model using creatinin/cystatin C and percent body fat provides strong predictive accuracy for identifying muscle impairment, and the addition of age further enhances performance

Article Details

References

[1] Choi J.H, Kim H.R, Song K.H. Musculoskeletal complications in patients with diabetes mellitus. Korean J Intern Med, 2022, 37 (6): 1099-1110. doi: https://doi.org/10.3904/kjim.2022.168
[2] Buch A, Ben-Yehuda A, Rouach V et al. Validation of a multi-frequency bioelectrical impedance analysis device for the assessment of body composition in older adults with type 2 diabetes. Nutr Diabetes, 2022, 12 (1): 45. doi: 10.1038/s41387-022-00223-1
[3] Hirai K, Tanaka A, Homma T et al. Serum creatinine/cystatin C ratio as a surrogate marker for sarcopenia in patients with chronic obstructive pulmonary disease. Clinical Nutrition, 2021, 40 (3): 1274-1280. doi: 10.1016/j.clnu.2020.08.010
[4] Zheng W.H, Hu Y.G, Yu D.X, Huang H.B. Creatinine-to-cystatin C ratio as muscle assessment tool and predictive value for mortality and sarcopenia in patients with chronic kidney disease: a meta-analysis. Front Nutr, 2025, 12: 1655488. doi: 10.3389/fnut.2025.1655488
[5] American Diabetes Association Professional Practice Committee. Older adults: standards of care in diabetes 2024. Diabetes Care, 2023, 47 (Supplement_1): S244-S257. doi: 10.2337/dc24-s013
[6] Studenski S.A, Peters K.W, Alley D.E et al. The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol A Biol Sci Med Sci, 2014, 69 (5): 547-558. doi: 10.1093/gerona/glu010
[7] Tseng T.H, Fu S.H, Sie N.H et al. Epidemiology of sarcopenia: a narrative review. Osteoporos Sarcopenia, 2025, 11 (2 Suppl): 11-21. doi: 10.1016/j.afos.2025.06.003
[8] Yang Q, Zhang M, Sun P et al. Cre/CysC ratio may predict muscle composition and is associated with glucose disposal ability and macrovascular disease in patients with type 2 diabetes. BMJ Open Diabetes Research & Care, 2021, 9 (2): e002430. doi: 10.1136/bmjdrc-2021-002430
[9] Shin J.Y. Low serum creatinine to cystatin C ratio is independently associated with sarcopenia and high carotid plaque score in patients with type 2 diabetes. Nutrition, Metabolism and Cardiovascular Diseases, 2022, 32 (6): 1454-1462. doi: 10.1016/j.numecd.2022.02.005