背景：我国老年2型糖尿病人群增长迅速，常合并有多种基础疾病，其自我管理水平普遍偏低，严重影响患者的生存质量。存在肌肉衰减状况的2型糖尿病患者可能有较差的糖尿病自我管理行为，且其普遍性和严重程度尚不明确。探究低自我管理行为患者的特征具有必要性，以期为制订老年2型糖尿病患者针对性的高效自我管理干预措施提供依据。

目的：描述老年2型糖尿病患者肌肉衰减现状；描述老年2型糖尿病患者糖尿病自我管理行为现状；探究老年2型糖尿病患者肌肉衰减与其糖尿病自我管理行为之间的关系。

方法：本研究为描述性研究。于2023年3月~2023年9月，采用便利抽样选取北京市方庄社区卫生服务中心就诊符合纳入标准的304名老年2型糖尿病患者作为研究对象。根据2019年亚洲肌肉衰减综合征工作组专家共识标准（Asian working group for sarcopenia, AWGS）对患者进行肌肉衰减筛查和相关健康检查，采用一般资料调查表、糖尿病自我管理行为量表、糖尿病自我效能感量表、慢性病病人健康素养量表展开调查。

结果：本研究共收集有效问卷304份。1.可能肌肉衰减综合征患者97例，占比31.91%(97/304)；肌肉衰减综合征患者47例，占比15.46%(47/304)，其中严重肌肉衰减综合征患者15例，占比4.93%(15/304)。不同肌肉衰减状况组间性别，年龄，饮酒情况，身体活动情况，优质蛋白摄入情况，糖尿病病程，腰臀比，体质指数（body mass index, BMI），运动锻炼效能感，四肢骨骼肌指数（appendicular skeletal muscle massindex, ASMI），握力，6米步速的差异有统计学差异（P<0.05）。2.对肌肉衰减的二元Logistic回归分析结果显示：年龄70岁及以上是患者肌肉衰减的危险因素；有饮酒情况、高优质蛋白摄入量、高BMI、高运动锻炼效能感是患者肌肉衰减的保护性因素。3.老年2型糖尿病患者的糖尿病自我管理行为得分为（4.26±1.09）分。各个维度得分从高到低依次为用药（6.32±1.92）分、特殊饮食（5.00±1.69）分、普通饮食（4.52±2.64）分、血糖监测（3.88±1.77）分、运动（3.56±2.15）分、足部护理（3.24±2.52）分。不同肌肉衰减状况的老年2型糖尿病患者的糖尿病自我管理行为和运动管理维度的差异有统计学意义（P<0.05）。老年2型糖尿病患者握力和6米步速的合格与不合格两组在运动管理维度的差异具有统计学意义（P<0.001）4.对糖尿病自我管理行为的多元线性回归分析结果显示：肌肉衰减、自我效能感、家庭人均月收入、6米步速、糖尿病并发症、职业情况、文化程度是糖尿病自我管理行为的影响因素。

结论：老年2型糖尿病患者肌肉衰减发生率较高，要更多关注70岁以上、优质蛋白摄入较少、BMI较低、运动锻炼效能感不高的患者。其糖尿病自我管理行为水平中等，仍未达到理想水平。其中，无肌肉衰减、自我效能感越高、6米步速越快、家庭人均月收入较高、文化程度较高、在职、有糖尿病并发症的患者糖尿病自我管理行为较好。老年2型糖尿病患者肌肉衰减与糖尿病自我管理行为关系密切。不同肌肉衰减状况患者的糖尿病自我管理行为水平不同，需要特别关注可能肌肉衰减综合征患者，尤其是运动管理行为。在临床工作中，建议医护人员通过6米步速对老年2型糖尿病患者进行肌肉衰减的初筛，尽早识别风险，并开展老年2型糖尿病患者针对性的健康管理，促进患者良好糖尿病自我管理行为的形成。

Background: The elderly type 2 diabetic population in China is rapidly increasing and often presents with multiple underlying diseases. Generally, their self-management levels are low, significantly affecting their quality of life. Type 2 diabetic patients with sarcopenia may exhibit poor diabetes self-management behaviors, and the prevalence and severity of this condition remains unclear. Investigating the characteristics of patients with low self-management behaviors is necessary to provide evidence for developing targeted and effective self-management interventions for elderly patients with type 2 diabetes.

Objective: To describe the current status of sarcopenia among elderly patients with type 2 diabetes. To describe the current state of diabetes self-management behaviors in elderly patients with type 2 diabetes. To investigate the relationship between sarcopenia and diabetes self-management behaviors in elderly patients with type 2 diabetes.

Methods: This descriptive study was conducted from March to September 2023. A convenience sample of 304 elderly patients with type 2 diabetes meeting the inclusion criteria was selected from the Fangzhuang Community Health Service Center in Beijing. Patients were screened for sarcopenia and underwent related health examinations based on the 2019 consensus criteria of the Asian Working Group for Sarcopenia (AWGS). Data collection was performed using a general information questionnaire, Diabetes Self-Management Behavior Scale, Diabetes Self-Efficacy Scale, and Chronic Disease Patient Health Literacy Scale.

Results: A total of 304 valid questionnaires were collected. 1. Ninety-seven participants, or 31.91% (97/304), were potential sarcopenia patients, and 47 patients, or 15.46% (47/304), were confirmed sarcopenia patients. Among these, 15 patients, or 4.93% (15/304), were identified as severe sarcopenia cases. There were statistically significant differences (P<0.05) in gender, age, drinking status, physical activity, intake of high-quality protein, duration of diabetes, waist-hip ratio, body mass index (BMI), exercise self-efficacy, appendicular skeletal muscle mass index (ASMI), grip strength, and 6-meter walking speed among groups with different sarcopenic conditions. 2. Bivariate logistic regression analysis on sarcopenia revealed that patients aged 70 and above were at risk of sarcopenia, while drinking, intake of high-quality protein, high BMI, and high exercise self-efficacy were protective factors. 3. The score for diabetes self-management behavior among elderly patients with type 2 diabetes was 4.26±1.09. Scores for each dimension in descending order were: medication (6.32±1.92), special diet (5.00±1.69), regular diet (4.52±2.64), blood glucose monitoring (3.88±1.77), exercise (3.56±2.15), and foot care (3.24±2.52). There were significant differences (P<0.05) in the total self-management score and the exercise management dimension among elderly patients with type 2 diabetes with different sarcopenic conditions. The difference in the exercise management dimension was statistically significant (P<0.001) between the groups qualified and unqualified in their grip strength and 6-meter walking speed. 4. Multivariate linear regression analysis on diabetes self-management behavior showed that sarcopenic, self-efficacy, monthly family income per capita, 6-meter walking speed, diabetes complications, occupation, and education level were influential factors, explaining 35.0% of the total variation.

Conclusion: Elderly patients with type 2 diabetes have a high prevalence of sarcopenia, particularly in those over 70 with low intake of quality protein, lower BMI, and diminished exercise efficacy. Their diabetes self-management is moderate and has not reached optimal levels. Those without sarcopenia, who have higher self-efficacy, faster 6-meter walk speeds, higher per capita family income, higher education levels, employment status, and diabetes complications, exhibit better diabetes self-management behaviors. The relationship between sarcopenia and diabetes self-management in elderly type 2 diabetic patients is closely linked. The level of diabetes self-management varies according to the degree of muscle depletion, necessitating special attention to potential sarcopenia syndrome patients, especially regarding exercise management practices. Clinically, it is recommended that healthcare professionals use the 6-meter walk speed test for initial screening of sarcopenia in elderly type 2 diabetic patients to identify risks early and implement targeted health management to promote effective diabetes self-management behaviors.