Evaluating grip strength to identify early diabetes

Healthcare practitioners can use assessment of normalized grip strength to routinely screen for type 2 diabetes in apparently healthy adults, according to a new study in the American Journal of Preventive Medicine

Ann Arbor, April 6, 2020

A new study in the American Journal of Preventive Medicine, published by Elsevier, reports valuable new grip strength metrics that provide healthcare practitioners with an easy-to-perform, time-efficient screening tool for type 2 diabetes (T2DM).

Muscular weakness is known to be associated with T2DM in otherwise seemingly healthy adults, however previous research had not found a way to assess this reliably. The current study was able to identify consistent grip strength cut points relative to body weight, gender, and age group in a large nationally representative sample of participants pre-screened for comorbid conditions such as hypertension.

“As the type 2 diabetes patient population continues to increase in the United States, diagnosing this disease in its early stages is becoming increasingly more important for preventing complications caused by blood vessel damage associated with diabetes,” explained lead investigator Elise C. Brown, PhD, Department of Public and Environmental Wellness, Oakland University, Rochester, MI, USA. “Our study identifies the levels of handgrip strength/weakness that correlate with T2DM in otherwise healthy men and women, according to their body weights and ages. Healthcare providers now have a reliable test to detect it early before such complications set in.”

T2DM is linked to increased cardiovascular-related morbidity and mortality. Undiagnosed prediabetes and T2DM in the US in 2017 were estimated to cost $43.4 and $31.7 billion, respectively. This economic burden highlights the need for better early detection efforts. T2DM is asymptomatic in its initial stages, and a prompt diagnosis can prevent  or delay vascular complications such as neuropathy, retinopathy and nephropathy.

Researchers analyzed survey data from the 2011-2012 and 2013-2014 National Health and Nutrition Examination Survey to establish normalized grip strength (grip strength relative to body weight) cut points for T2DM risk. Inexpensive portable handgrip dynamometer devices were used to determine hand and forearm strength. After controlling for sociodemographics (i.e., race/ethnicity, education, poverty, sex, and age), lifestyle factors (i.e., sedentary behavior, alcohol use, and smoking status), and waist circumference, the investigators identified the grip strength levels of at-risk patients who were otherwise healthy. These levels are presented with age- and sex-specific grip strength cut points that correspond to varying body weights to increase the ease of use for practitioners as indicators of when further diabetes diagnostic testing is warranted.

Poster illustrating the benefits of early diabetes detection through normalized grip strength. Cut points established by this study aid the identification of individuals at risk for type 2 diabetes.
Evaluating normalized grip strength. Cut points established by this study aid the identification of individuals at risk for type 2 diabetes. Credit: Oakland University and the University of the West of Scotland.

For example, the cut point for women aged 50-80 years is 0.49. This means that if a 60-year old woman’s combined grip strength from left and right hands was 43 kg, and her body weight was 90 kg, her normalized grip strength would be 0.478. Since this value is less than 0.49, this indicates that she is at increased risk for diabetes and further screening is warranted.

“Given the low cost, minimal training requirement and quickness of the assessment, the use of the normalized grip strength cut points in this paper could be used in routine health screenings to identify at-risk patients and improve diagnosis and outcomes,” added Dr. Brown. “This type of impactful research can make a difference for practitioners and individuals and is a key focal point of what Oakland University is all about. We are trying to improve the health and wellbeing of individuals.”


Notes for editors
The article is “Grip Strength Cut Points for Diabetes Risk Among Apparently Healthy U.S. Adults,” by Elise C. Brown, PhD, Duncan S. Buchan, PhD, Samar A. Madi, MS, Breanne N. Gordon, BS,and Dorin Drignei, PhD (https://doi.org/10.1016/j.amepre.2020.01.016). It will appear in the American Journal of Preventive Medicine, volume 58, issue 6 (June 2020) published by Elsevier.

This study was funded through the Oakland University Faculty Research Fellowship.

Full text of this article is available to credentialed journalists upon request; contact Jillian B. Morgan at +1 734 936 1590 or ajpmmedia@elsevier.com. It will also be openly available for 60 days following publication. Journalists wishing to interview the authors should contact Eric Reikowski, Public Information Specialist, at +1 248 370 4348 or esreikow@oakland.edu.

About the American Journal of Preventive Medicine
The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials. www.ajpmonline.org

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers. www.elsevier.com

Media contact

Jillian B. Morgan, MPH, Managing Editor
+1 734 936 1590