Effect of diabetic kidney disease complications on fatigability in patients with type 2 diabetes mellitus

Purpose Type 2 diabetes mellitus (T2DM) emphasizes the maintenance of high levels of physical activity and requires interventions tailored to the characteristics of each patient. We hypothesized that T2DM combined with diabetic kidney disease (DKD) could increase skeletal muscle fatigability, becoming a specific contributor to physical inactivity. This study aimed to determine the effects of DKD complications on fatigability and the relationship between fatigability and physical activity in patients with T2DM. Methods The participants were 50 patients with T2DM aged 40–65 years with an estimated glomerular filtration rate of 30 ml/min/1.73 m2 or higher. An experimental protocol was performed using a isokinetic dynamometer to assess muscle function. Fatigability (maximal voluntary concentric contraction [ΔMVCC] velocity, maximal voluntary isometric contraction [ΔMVIC] torque) was calculated, indicating the decrease in angular velocity and muscle strength associated with the exercise task. The patient characteristics, physical activity (IPAQ-SV), knee extension strength, and skeletal muscle index were evaluated. Participants were divided into two groups (DKD and non-DKD) according to the presence or absence of DKD, and ΔMVCC velocity and ΔMVIC torque were compared. Results ΔMVCC velocity was significantly higher in the DKD group than that in the non-DKD group (p<0.05). Similarly, ΔMVIC torque was significantly higher in the DKD group compared with the non-DKD group (p<0.05). Subgroup analysis showed that ΔMVCC velocity was independently associated with physical activity in the DKD group (odds ratio: 0.045, 95% confidence interval: 0.913–0.999). Conclusion Fatigability increased with DKD in patients with T2DM and may be related to physical activity. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the Clinical Research Ethics Committee of the Hamamatsu University School of Medicine (20-002). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data presented in this study are available upon request from the corresponding author. The data are not publicly available because they are the property of the Institute of Hamamatsu University Hospital, Japan. Data are available from the Hmamatsu University School of Medicine Data Access (contact via Yuma Hirano) for researchers who meet the criteria for access to confidential data.