Early and underestimated: sarcopenia emerges as a neuropathy-linked complication in type 2 diabetes
Aims: To estimate the prevalence of sarcopenia and identify associated risk factors among middle-aged and older adults with type 2 diabetes mellitus (T2DM) in Asian populations.
Methods: This systematic review and meta-analysis included 43 observational studies comprising 19,055 individuals aged ≥45 years with T2DM. Data were extracted from major databases, including PubMed, Embase, Cochrane Library, Web of Science, and CINAHL up to August 2025. Sarcopenia prevalence and associated risk factors were pooled using random-effects models, and study quality was assessed using the Newcastle–Ottawa Scale. According to the 2014 and 2019 consensus of the Asian Working Group for Sarcopenia (AWGS), sarcopenia was diagnosed when low skeletal muscle mass is accompanied by either reduced muscle strength or impaired physical performance. Severe sarcopenia was defined when all three components—low muscle mass, low muscle strength, and poor physical performance—were concurrently present.
Results: The pooled prevalence of sarcopenia in individuals with T2DM was 17% (95% CI 14–21%), with similar rates observed in middle-aged (13%) and older adults (17%), showing no significant age-related difference. Increasing age was associated with a higher risk (OR 1.12), as was higher HbA1c (OR 1.11). Diabetic nephropathy was also associated with increased risk (OR 1.76), while diabetic neuropathy showed the strongest association with sarcopenia (OR 3.28). Higher body fat percentage was positively associated with sarcopenia, whereas higher BMI (OR 0.66), better nutritional status, and metformin use (OR 0.26) were associated with lower risk.
Conclusions: Sarcopenia is a common complication of T2DM and occurs not only in older individuals but also in middle-aged patients. Its strong association with diabetic neuropathy suggests shared mechanisms beyond ageing and hyperglycaemia.
Comments: This study highlights sarcopenia as an important and underrecognized complication of T2DM, closely linked to neuropathy. The absence of a significant difference in prevalence between middle-aged and older individuals suggests that diabetes-related mechanisms, rather than ageing alone, play a key role in muscle decline. The strong association with neuropathy supports the concept of a neuro-muscular axis, where denervation, impaired motor unit recruitment, and reduced neuromuscular function contribute to progressive muscle loss. While poor glycaemic control remains an important contributor, the magnitude of the association with neuropathy indicates that additional mechanisms such as inflammation, mitochondrial dysfunction, and neural damage may be critical drivers. The protective association observed with metformin is of particular interest and may reflect benefits beyond glucose lowering, potentially involving anti-inflammatory or metabolic effects on skeletal muscle. Strengths of the study include a large sample size and comprehensive synthesis of available evidence, while limitations include high heterogeneity, predominance of cross-sectional data, and variability in sarcopenia definitions. These findings support earlier screening for sarcopenia in individuals with T2DM, particularly in those with neuropathy, and emphasize the need for integrated approaches targeting both neural and muscular complications.
Aleksandra Araszkiewicz
Reference. Wu YC, Mao MT, Huang HE, Huang CN, Liao WC. Prevalence and risk factors of sarcopenia in Asian adults with type 2 diabetes: A systematic review and meta-analysis. J Diabetes Investig. 2026 Jan;17(1):83-95. doi: 10.1111/jdi.70185. Epub 2025 Oct 30. PMID: 41165506; PMCID: PMC12757673.
