Low serum creatinine to cystatin C ratio is independently associated with sarcopenia and high carotid plaque score in patients with type 2 diabetes

  • Author Footnotes
    1 Department of Internal Medicine, Yonsei University, Wonju College of Medicine, 20 Ilsan-ro, Wonju-si, Gangwon-do, 24642, Republic of Korea.
    Jang Yel Shin
    1 Department of Internal Medicine, Yonsei University, Wonju College of Medicine, 20 Ilsan-ro, Wonju-si, Gangwon-do, 24642, Republic of Korea.
    Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
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  • Author Footnotes
    1 Department of Internal Medicine, Yonsei University, Wonju College of Medicine, 20 Ilsan-ro, Wonju-si, Gangwon-do, 24642, Republic of Korea.
Published:February 11, 2022DOI:


      • CCR was positively correlated with appendicular skeletal muscle (ASM)/ body mass index (BMI) and grip strength (GS) in both genders.
      • Low CCR was independently associated with high carotid plaque score, especially after adjusting for ASM/ BMI and GS.


      Background and aims

      Low serum creatinine (Cr) to cystatin C (cysC) ratio has been suggested to be associated with low muscle mass and strength and poor prognosis in various chronic disease. We investigated the associations of CCR with sarcopenia and carotid plaque score (PS) in patients with type 2 diabetes mellitus.

      Methods and results

      A total of 1577 patients with type 2 diabetes were enrolled. High PS was defined as PS ≥ 3. Sarcopenia was assessed by the measurement of appendicular skeletal muscle mass (ASM) and grip strength (GS). Compared to the highest CCR group, the lowest tertile group was older; had higher C-reactive protein levels, CIMT, and PS, but lower cysC-based estimated glomerular filtration rate (cysC-eGFR), ASM/BMI, and GS. Positive correlations between CCR and ASM/BMI (r = 0.239 in men and 0.303 in women, p < 0.001) and GS (r = 0.282 in men and 0.270 in women, p < 0.001) were observed in both genders. Odds ratios and 95% confidence intervals for high PS after adjusting for age and sex were 1.22 (0.92–1.61, p = 0.18) in the middle and 1.74 (1.31–2.30, p < 0.001) in the lowest tertiles, respectively, with those of the lowest tertile remaining significant after further adjusting for multiple confounders.


      Low CCR was independently associated with sarcopenia and high PS in patients with type 2 diabetes mellitus, especially after adjusting for ASM/BMI and GS.



      ASM (appendicular skeletal muscle mass), BMI (body mass index), CCA (common carotid artery), CI (confidence interval), CIMT (carotid intima media thickness), CKD (chronic kidney disease), Cr (creatinine), cysC (cystatin C), CCR (Cr to cysC ratio), CVD (cardiovascular disease), DBP (diastolic blood pressure), eGFR (estimated glomerular filtration rate), FBG (fasting blood glucose), GS (grip strength), HbA1c (glycated hemoglobin), HDL (high-density lipoprotein), HOMA-IR (homeostasis model assessment–insulin resistance), hs-CRP (high-sensitive C-reactive protein), ICU (intensive care unit), OR (odds ratio), PS (plaque score), SBP (systolic blood pressure), TG (triglyceride), WC (waist circumference)
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