PhilSPEN Online Journal of Parenteral and Enteral Nutrition

(Article 136 | POJ_0128)

Original Clinical Investigation

Hand Grip Dynamometer Status of Diabetes patients versus Non-Diabetes patients

Abstract | Introduction | Methodology | Results | Discussion | Conclusion | References | Back to Total Name and Codes page2

Submitted: | Posted:

 

Authors:

    1. Carla de Vera, RND; Clinical Nutrition Service, St. Luke's Medical Center, Quezon City, Philippines
    2. Butch Navarette, RND, St. Luke's Medical Center, Quezon City, Philippines
    3. Luisito O. Llido, MD; Clinical Nutrition Service, St. Luke’s Medical Center, Quezon City, Philippines
    Corresponding Author: Carla de Vera, RND

Institution where research was conducted

Clinical Nutrition Sevice, St. Luke’s Medical Center, E. Rodriguez Avenue, Quezon City, Metro-Manila, Philippines

 

ABSTRACT: | Back

Background:

To perform a study on the use of hand held grip measurements for use in diabetes and non-diabetics as an indicator of strength and nutritional status in whichever arm is used (probably major arm)

Objective:

To measure the relationship of objective hand grip strength among non-diabetes versus diabetics using a calibrated dynamometer among population on varying ages, sexes, nutritional and functional status among well and sick diabetic patients.

Methodology:

Hand grip measurement is done based on the following Filipino patients. Patients who are not diabetic are measured first, then the diabetes patients are followed. Then we determine if there is significant difference on the values of hand grip strength between diabetes and non-diabetes patients. Then the patients are grouped into diabetes patients and non-diabetes patients based on their gender. They are further grouped according to their BMI in terms of their being diabetic and non-diabetic.

Results:

304 patients were included in the study. The total number of patients who were normal were 207 patients while the patients who had diabetes were 34. Taking these data, it shows that diabetes patients had lower hand grip data compared to those who had no diabetes in the range of 34/207 or 12.6%.

Conclusion:

Hand grip strength monitoring is a valuable tool for measuring nutritional status especially in diabetes patients whose grip strength is lower than those of non-diabetic patients at around 12.6%.

 

KEYWORDS: Hand Grip Dynamometry, Diabetes patients

 

INTRODUCTION | Back

Diabetes is manifested by reduced muscle strength due to lesser capacity of the muscle cells to utilize glucose load. This reduction of body mass is manifested by: lower capacity to undertake exercises, shortened capacity for muscular and respiratory activity resulting to pulmonary fatigue compared to the ones who have no diabetes, reduced capacity to counteract infection (also in its relation to have lower immune response) and reduced general immune response to all forms of trauma and injury. There is also an increased level of sarcopenia compared to non-diabetics.

Using these information we determine if there is a difference in terms of strength of the overall muscle mass and strength of nutritional status among diabetes patients compared to the non-diabetes patients.

METHODOLOGY | Back

A total patients of 304 patients were included in the study. Patients who had diabetes were 34 in number with a total prevalence of 34/304 or 12.6% whose hand grip are lower than their diabetic counterparts. Patients who had no diabetes were normal = 270. Patients underwent weight (in kg) and age analysis to determine their hand grip dynamometry and compared them with diabetes versus non-diabetics. Statistical analysis: T-Test.

RESULTS | Back

  1. Total patients = 304 patients.
  2. Patients who had diabetes equals 34 and 34/270 = 12.6% lower than their non-diabetic counterparts.
  3. Patients who had no diabetes = 270

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DISCUSSION: | Back

Diabetic patients will have a lower hand grip status in the over-all scenario. (1-3). This will explain the following reasons:

  1. They have lower muscle mass.
  2. They have lower susceptibility to withstand infections or any immune injury (as in trauma related or sepsis involved).
  3. Diabetes patients have increased levels of sarcopenia. 

Thus diabetic patients need closer monitoring of their overall status. Based on this research and the practicality of hand-grip dynamometry, the measurement of grip strength has been widely adopted as a singular indicator of overall strength.

Evidence is also provided for a predictive link between grip strength and all-cause and disease-specific mortality, future function, bone mineral density, fractures, cognition and depression, and problems associated with hospitalization. Consequently, the routine use of grip strength can be recommended as a stand-alone measurement or as a component of a small battery of measurements for identifying older adults at risk of poor health status.

For the Nutritional Risk Screening the best cut-points were 27.5kg for men 65–74 years, 21.0 kg for men 75–90 years, 17.0kg for women 65–74 years, and 14.6kg for women 75–90 years. For the Subjective Global Assessment, the optimal cut-points were 24.9kg for men 65–74 years, 20.8kg for men 75–90 years, 15.2kg for women 65–74 years, and 13.5kg for women 75–90 years.

The literature is inconsistent, but hospital and rehabilitation length of stay and readmission have been shown in several studies to correlate with grip strength.

CONCLUSION: | Back

Patients with diabetes are present in 12.6% of total patients in a given population. Hand grip status of patients in the diabetic group is lower than the hand grip status of patients in the non-diabetic group.

REFERENCES: | Back

  1. Avares da silva (2005) Comparison of hand-grip strength, subjective global assessment, and nutrition risk screening in in predicting clinical outcome in cirrhotic patients nutrition (113-117)
  2. Barbara Vogt, Mariana Borges, Handgrip strength is an independent predictor of all-cause mortality in maintainance dialysis patient, Clinical Nutrition 35(2016) 1429
  3. Bohannon RW. Clinical Interventions in Aging, 2019; 14. 1681-91.
  4. Bohannon RW. Muscle strength : clinical and prognostic value of hand grip dynamometry: clinical opinion in clinical nutrition and metabolic care 2015;18(5)
  5. Flood A, Chung. The use of handgrip strength as a predictor of nutrition status in hospital patients. Clinical nutrition 2014(33:106-14)
  6. Kortebein P: Rehabilitation for hospital associated deconditioning, Am J Phys Med 2009; 88:66
  7. Zhang XS, Liu YH, Zhang Y, et al. Handgrip strength as a predictor of nutritional status in  elderly inpatients at hospital admission. Biomed Environ Sci. 2017; 30(11): 802–810. doi:10.3967/bes2017.108

Abstract | Introduction | Methodology | Results | Discussion | References | Back to Total Name and Codes page2