DYNAMICS OF MYOKINE STATUS AND METABOLIC PARAMETERS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND SARCOPENIA RECEIVING COMPREHENSIVE THERAPY

Sarcopenia and type 2 diabetes mellitus (T2DM) share common pathophysiological mechanisms and are mutually aggravating, which makes the search for pathogenetically justified treatment approaches an urgent task. The present study examined changes in myokine status and metabolic parameters in patients with T2DM and sarcopenia receiving comprehensive therapy. A total of 55 patients aged 55 to 65 years were examined: 35 patients with T2DM and sarcopenia (Group 1) and 20 patients with T2DM without sarcopenia (Group 2). Sarcopenia was diagnosed according to the EWGSOP criteria using handgrip dynamometry, dual-energy X-ray absorptiometry, and a gait speed test. Comprehensive therapy comprised optimized glucose-lowering treatment, loading doses of vitamin D, a high-protein diet, and an individualized program of aerobic and resistance training. After six months, both groups achieved comparable improvement in carbohydrate metabolism, whereas the reduction in insulin resistance was more pronounced in Group 1 (HOMA-IR decreased 1.74-fold versus 1.41-fold in Group 2). In patients with sarcopenia, serum myostatin decreased by 33.6%, irisin increased 1.67-fold, and vitamin D reached optimal values. These changes were accompanied by significant gains in handgrip strength, skeletal muscle index, and gait speed. Before treatment, myostatin correlated positively with insulin resistance and inversely with muscle strength, vitamin D level, and gait speed; after treatment these associations weakened. The findings demonstrate the reversibility of sarcopenic processes when pathogenetic treatment is started in a timely manner. However, muscle function indicators in Group 1 remained lower than in patients without sarcopenia, indicating the need for prolonged rehabilitation and long-term monitoring of myokine status.