{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T22:29:37Z","timestamp":1773268177280,"version":"3.50.1"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The association of muscle weakness with poor outcomes is well defined in general older population, but there is insufficient data on the association of muscle weakness with functionality in older patients with diabetes mellitus (DM). We aimed to investigate the predictivity of muscle weakness defined as low grip strength thresholds determined by EWGSOP2, and two regional thresholds in older patients with DM for functional disability. Activities of Daily Living (ADL), Instrumental ADL (IADL), grip strength, comorbidities, anthropometric and biochemical data from outpatient clinic medical records were screened retrospectively. Low grip strength was determined by EWGSOP2, and two regional thresholds. Receiver operating characteristic (ROC) analysis, sensitivity and negative predictive values were conducted to identify the discrimination power of three different grip strength thresholds for functional disability in patients with DM. A total of 197 patients with DM and 215 controls were included. In ROC analyses, regional thresholds were with higher sensitivity and negative predictive values for functional disability in both groups. For patients with DM, regional normative thresholds predicted functional disability both for ADLs and IADLs whereas for patients without DM normative thresholds predicted ADL, and calculated thresholds predicted IADL disability. Regional normative thresholds predicted both ADL and IADL functional disability in older patients with DM.<\/jats:p>","DOI":"10.1371\/journal.pone.0317250","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T18:30:59Z","timestamp":1738261859000},"page":"e0317250","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["The association of muscle weakness with functional disability in older patients with Diabetes mellitus: Measured by three different grip strength thresholds"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4570-3071","authenticated-orcid":true,"given":"Sibel","family":"\u00c7avdar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6447-2352","authenticated-orcid":true,"given":"Fatma Ozge Kayhan","family":"Kocak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumru","family":"Savas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,1,30]]},"reference":[{"issue":"Suppl 1","key":"pone.0317250.ref001","first-page":"S195","article-title":"13. Older Adults: Standards of Medical Care in Diabetes-2022","volume":"45","author":"B Draznin","year":"2022","journal-title":"Diabetes care"},{"key":"pone.0317250.ref002","doi-asserted-by":"crossref","first-page":"104437","DOI":"10.1016\/j.archger.2021.104437","article-title":"The vicious cycle in the development of diabetes mellitus and sarcopenia in older persons","volume":"95","author":"LK Chen","year":"2021","journal-title":"Archives of gerontology and geriatrics"},{"issue":"1","key":"pone.0317250.ref003","doi-asserted-by":"crossref","first-page":"14790","DOI":"10.1038\/s41598-020-71908-9","article-title":"Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025","volume":"10","author":"X Lin","year":"2020","journal-title":"Scientific reports"},{"issue":"1","key":"pone.0317250.ref004","doi-asserted-by":"crossref","first-page":"82","DOI":"10.2337\/dc14-1166","article-title":"Hyperglycemia predicts persistently lower 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65\u201375 years: pooled analysis of four European cohort studies","volume":"19","author":"NH Jonkman","year":"2019","journal-title":"BMC geriatrics"},{"issue":"1","key":"pone.0317250.ref013","first-page":"63","article-title":"Ya\u015fl\u0131 Diyabetiklerde Kas G\u00fcc\u00fc ve Performans\u0131n\u0131n Tedavi Y\u00f6netimindeki \u00d6nemi","volume":"31","author":"R Bah\u015fi","year":"2021","journal-title":"J \u0130zmir Tepecik E\u011fitim Hastanesi Dergisi"},{"issue":"2","key":"pone.0317250.ref014","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1111\/ggi.14339","article-title":"Skeletal muscle as a treatment target for older adults with diabetes mellitus: The importance of a multimodal intervention based on functional category","volume":"22","author":"T Omura","year":"2022","journal-title":"Geriatrics & gerontology 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Bahat","year":"2021","journal-title":"Aging Clin Exp Res"},{"issue":"9","key":"pone.0317250.ref021","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1007\/s40520-019-01448-4","article-title":"Validation of population-based cutoffs for low muscle mass and strength in a population of Turkish elderly adults","volume":"32","author":"E Ates Bulut","year":"2020","journal-title":"Aging Clin Exp Res"},{"key":"pone.0317250.ref022","unstructured":"Centers for Disease Control and Prevention (CDC). National Health and Nutrition Examination Survey (NHANES). muscle strength procedures manual 2013. [updated 11.03.2022. Available from: https:\/\/wwwn.cdc.gov\/nchs\/data\/nhanes\/2013-2014\/manuals\/muscle_strength_2013.pdf."},{"issue":"12","key":"pone.0317250.ref023","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1111\/j.1532-5415.1983.tb03391.x","article-title":"Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living","volume":"31","author":"S. Katz","year":"1983","journal-title":"Journal of the American Geriatrics Society"},{"issue":"3","key":"pone.0317250.ref024","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1093\/geront\/9.3_Part_1.179","article-title":"Assessment of older people: self-maintaining and instrumental activities of daily living","volume":"9","author":"MP Lawton","year":"1969","journal-title":"The Gerontologist"},{"issue":"3","key":"pone.0317250.ref025","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.archger.2015.08.019","article-title":"Validation of Katz index of independence in activities of daily living in Turkish older adults","volume":"61","author":"G Arik","year":"2015","journal-title":"Archives of gerontology and geriatrics"},{"key":"pone.0317250.ref026","unstructured":"Yard\u0131mc\u0131 AE. \u0130stanbul\u2019da Ya\u015fayan Ya\u015fl\u0131 \u00d6\u011fretmenlerin Sa\u011fl\u0131k Sonu\u00e7lar\u0131n\u0131n G\u00fcnl\u00fck Ya\u015fam Aktiviteleri ve Aletli G\u00fcnl\u00fck Ya\u015fam Aktiviteleri \u0130le \u0130li\u015fkisi [T\u0131pta Uzmanl\u0131k Tezi]. Istanbul: \u0130stanbul \u00dcniversitesi T\u0131p Fak\u00fcltesi; 1995. https:\/\/nek.istanbul.edu.tr\/ekos\/TEZ\/29375.pdf"},{"issue":"1","key":"pone.0317250.ref027","first-page":"59","article-title":"Turkish validity and reliability of the Lawton instrumental activities of daily living scale","volume":"22","author":"A G\u00fczel","year":"2024","journal-title":"Turkish Journal of Public Health"},{"issue":"2","key":"pone.0317250.ref028","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"F Faul","year":"2007","journal-title":"Behavior research methods"},{"issue":"3","key":"pone.0317250.ref029","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1111\/j.1651-2227.2006.00180.x","article-title":"Understanding diagnostic tests 1: sensitivity, specificity and predictive values","volume":"96","author":"AK Akobeng","year":"2007","journal-title":"Acta paediatrica (Oslo, Norway: 1992)"},{"key":"pone.0317250.ref030","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.clnesp.2018.02.005","article-title":"review of the validity of malnutrition screening tools used in older adults in community and healthcare settings \u2010 A MaNuEL study","volume":"24","author":"L Power","year":"2018","journal-title":"AClinical nutrition ESPEN"},{"issue":"7","key":"pone.0317250.ref031","doi-asserted-by":"crossref","DOI":"10.3390\/nu13072183","article-title":"Diagnostic Performance and Accuracy of the MNA-SF against GLIM Criteria in Community-Dwelling Older Adults from Poland","volume":"13","author":"A Kalu\u017aniak-Szymanowska","year":"2021","journal-title":"Nutrients"},{"key":"pone.0317250.ref032","doi-asserted-by":"crossref","first-page":"307","DOI":"10.3389\/fpubh.2017.00307","article-title":"Sensitivity, Specificity, and Predictive Values: Foundations, Pliabilities, and Pitfalls in Research and Practice","volume":"5","author":"R Trevethan","year":"2017","journal-title":"Frontiers in public health"},{"issue":"9","key":"pone.0317250.ref033","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1097\/JTO.0b013e3181ec173d","article-title":"Receiver Operating Characteristic Curve in Diagnostic Test Assessment","volume":"5","author":"JN Mandrekar","year":"2010","journal-title":"Journal of Thoracic Oncology"},{"key":"pone.0317250.ref034","unstructured":"Significance of the Difference between the Areas under Two Independent ROC Curves 2024 [Available from: http:\/\/vassarstats.net\/roc_comp.html."},{"issue":"2","key":"pone.0317250.ref035","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s41999-019-00256-3","article-title":"A cross-sectional study on sarcopenia using EWGSOP1 and EWGSOP2 criteria with regional thresholds and different adjustments in a specific geriatric outpatient clinic","volume":"11","author":"S Savas","year":"2020","journal-title":"European 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functionality","volume":"23","author":"G Bahat","year":"2020","journal-title":"The aging male: the official journal of the International Society for the Study of the Aging Male"},{"issue":"5","key":"pone.0317250.ref039","doi-asserted-by":"crossref","first-page":"1564","DOI":"10.1080\/13685538.2020.1870038","article-title":"Comparison of standard versus population-specific handgrip strength cut-off points in the detection of probable sarcopenia after launch of EWGSOP2","volume":"23","author":"G Bahat","year":"2020","journal-title":"The aging male: the official journal of the International Society for the Study of the Aging Male"},{"key":"pone.0317250.ref040","doi-asserted-by":"crossref","first-page":"110835","DOI":"10.1016\/j.exger.2020.110835","article-title":"Difference in sarcopenia prevalence and associated factors according to 2010 and 2018 European consensus (EWGSOP) in elderly patients with type 2 diabetes mellitus","volume":"132","author":"MM de 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Journal of clinical medicine"},{"issue":"9","key":"pone.0317250.ref043","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1007\/s40520-019-01351-y","article-title":"Weakness and cognitive impairment are independently and jointly associated with functional decline in aging Americans","volume":"32","author":"R McGrath","year":"2020","journal-title":"Aging Clin Exp Res"},{"issue":"8","key":"pone.0317250.ref044","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1007\/s12603-016-0801-3","article-title":"Frailty, Diabetes, and Mortality in Middle-Aged African Americans","volume":"20","author":"S Chode","year":"2016","journal-title":"The journal of nutrition, health & aging"},{"issue":"4","key":"pone.0317250.ref045","doi-asserted-by":"crossref","first-page":"160","DOI":"10.4235\/agmr.19.0038","article-title":"Diabetes and Muscle Dysfunction in Older Adults","volume":"23","author":"HC Jang","year":"2019","journal-title":"Annals of geriatric medicine and research"},{"issue":"6","key":"pone.0317250.ref046","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1136\/emermed-2017-206735","article-title":"What is an ROC curve? 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