Purpose Muscle strength is associated with type 2 diabetes mellitus (T2DM). However, it is controversial whether muscle strength and normalized muscle strength is a risk factor for T2DM. Moreover, the relationship of back muscle strength (BMS) and incident T2DM has not been reported. In this study, we investigated the relationship between HGS, BMS, normalized HGS and BMS, and incident T2DM. Methods A total of 2699 non-diabetes subjects aged 40–69 years (1313 women and 1386 men) in the Korean Genome and Epidemiology Study (KoGES) Ansan cohort were followed for 16 years. At the baseline and biennial follow‐up visits, fasting glucose, postprandial 2-h glucose, clinical examinations, HGS, and BMS were measured by trained interviewers and examiners. HGS and BMS were measured at baseline. The relationships between incident T2DM, HGS, BMS, and normalized HGS and BMS were estimated using Cox proportional hazard regression models after adjusting for the confounding factors. Results HGS and BMS were not associated with incident T2DM in multivariate analysis. However, the hazard ratio (HR) per one standard deviation (SD) increase in the body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR)-normalized HGS, and BMS was associated with a lower risk for incident T2DM in both women and men after adjusting for the confounding factors (HR = 0.842–0.880-fold for women, p ≤ 0.015; HR = 0.887–0.903-fold for men, p ≤ 0.024). In the sub-analysis of menopause status, the HR per one SD increase in BMI, weight 2/3 , WC, and WHR-normalized HGS was associated with a lower risk for incident T2DM in both pre- and post-menopausal women after adjusting for the confounding factors (HR = 0.860–0.820-fold for premenopausal, P ≤ 0.006; HR = 0.900–0.867-fold for postmenopausal, p ≤ 0.024). Additionally, we confirmed that the quartile group with higher muscle strength was associated with a lower risk for incident T2DM. Conclusion The present study suggested that normalized HGS and BMS were associated with a lower risk for the future development of T2DM. Moreover, weak muscle strength in premenopausal women may be the cause of T2DM. Further research is needed to determine whether efforts to improve muscle strength, such as exercise can reduce the risk of T2DM.

Muscle strength is associated with health outcomes and can be considered an important disease predictor. There are several studies examining the relationship between hand grip strength (HGS) and metabolic syndrome (MetS). However, no results have been reported for long term longitudinal studies. In this study, we investigated the relationship between mean HGS, back muscle strength (BMS), relative HGS and BMS, and MetS. A total of 2538 non-MetS subjects aged 40–69 years (1215 women and 1323 men) in the Korean Genome and Epidemiology Study (KoGES) Ansan cohort were followed for 16 years. The relationships between incident MetS (iMetS) and muscle strength were estimated using Cox proportional hazard regression models after adjusting for the confounding factors. Increases in standard deviation (SD) and the lower quartile groups for relative HGS and BMS were significantly associated with iMetS in men and women. Moreover, increases in SD and high quintile groups (decreased HGS group) for the delta change in the mean and relative HGS were significantly associated with iMetS in men only. In addition, SD increases for the relative HGS and BMS were significantly associated with iMetS components in men and women. The present study suggests that lower relative HGS and BMS are associated with high risk for the future development of MetS.