Use of computed tomography to identify muscle quality subgroups, spatial mapping, and preliminary relationships to function in those with diabetic peripheral neuropathy.
Emilia M Kaszyk, Paul K Commean, Gretchen A Meyer and 7 others
PMID 38797052WHAT IT FOUND
In people with diabetic neuropathy, foot muscle quality worsened over 3.6 years, with normal muscle shrinking and fat infiltration rising.
Lower muscle quality was associated with worse self-reported walking ability. These CT measures may help identify patients at higher risk of foot deformity.
Key findings
01Over 3.6 years, normal muscle volume decreased significantly while fat infiltration increased, with a mean loss of 1.20 cm³/year for normal muscle.
02Greater percentage of normal muscle was associated with higher self-reported walking ability (FAAM score) at follow-up.
03CT analysis revealed that only 48.5% of the intrinsic foot muscle compartment was normal muscle at baseline, with the remainder being abnormal tissue or fat.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study is a retrospective analysis of a trial not originally designed to test these specific CT outcomes, so the power analysis was not based on this manuscript. The relationship between muscle quality and function was exploratory and correlational, meaning it cannot prove that poor muscle quality causes functional decline. CT scans involve radiation exposure, although the dose was limited to the feet. The analysis did not include a control group of people without DPN, making it difficult to separate the effects of neuropathy from normal aging. Segmentation of the muscle compartment involves some subjective error in defining boundaries.
Declared interests
The study was supported by the National Institutes of Health. No other conflicts of interest were declared.
The easy way to misread this
Do not assume that improving muscle quality through therapy will automatically improve function or prevent deformities. This study observed a correlation in a natural history context; it did not test whether an intervention could reverse the muscle loss or improve outcomes.