A Narrative Review on Sarcopenia in Type 2 Diabetes Mellitus: Prevalence and Associated Factors

Abstract

Type 2 diabetes mellitus (T2DM) represents a major health burden for the elderly population, affecting approximately 25% of people over the age of 65 years. This percentage is expected to increase dramatically in the next decades in relation to the increased longevity of the population observed in recent years. Beyond microvascular and macrovascular complications, sarcopenia has been described as a new diabetes complication in the elderly population. Increasing attention has been paid by researchers and clinicians to this age-related condition—characterized by loss of skeletal muscle mass together with the loss of muscle power and function—in individuals with T2DM; this is due to the heavy impact that sarcopenia may have on physical and psychosocial health of diabetic patients, thus affecting their quality of life. The aim of this narrative review is to provide an update on: (1) the risk of sarcopenia in individuals with T2DM, and (2) its association with relevant features of patients with T2DM such as age, gender, body mass index, disease duration, glycemic control, presence of microvascular or macrovascular complications, nutritional status, and glucose-lowering drugs. From a clinical point of view, it is necessary to improve the ability of physicians and dietitians to recognize early sarcopenia and its risk factors in patients with T2DM in order to make appropriate therapeutic approaches able to prevent and treat this condition.

The Cre/CysC Ratio Can Predict Muscle Composition and is Associated with Glucose Disposal Ability and Macrovascular Disease in Patients with Type 2 Diabetes

“…These results indicate that patients with high levels of Cre/CysC may have better postprandial glucose disposal ability, even though they showed no differences in pancreatic function and insulin sensitivity. The present study did show a correlation between Cre/CysC and HbA1c, which is consistent with previous epidemiological studies showing that HbA1c is not associated with sarcopenia in type 2 diabetes individuals [3]. However, a relationship between glucose control and sarcopenia cannot be completely excluded.…”

“…A recent systematic review including 1,832 patients with type 2 diabetes and 4,694 euglycaemic subjects demonstrated that patients with type 2 diabetes have a higher risk of sarcopenia (OR: 1.55, [95% CI: 1.25-1.91]). Considering its heavy impact on quality of life and increased risk of fracture, disability and mortality, sarcopenia is emerging as a third category of diabetic complication [3,4].…”

Nutrition in Patients with Type 2 Diabetes: Present Knowledge and Remaining Challenges

“…The prevalence of sarcopenia in diabetes has been extensively investigated. In a recent narrative review, the prevalence of sarcopenia varied between 7% and 29% [ 21 ], according to age and metabolic control, but higher figures are frequently reported. A systematic review with meta-analysis including 15 studies confirmed a prevalence varying up to 50% [ 22 ], again driven by age and metabolic control.…”

“…A study with BIA concluded that patients with T2D have an enlarged ectopic fat at the expense of skeletal muscle, i.e., relative sarcopenia [ 23 ], and lower muscle mass is coupled with decreased muscle strength [ 24 ], also predicting diabetes in the general population [ 25 ]. The contribution of diabetes duration remains controversial [ 21 , 22 ], but older patients with T2D, with an expected longer duration of disease, show a larger decline in appendicular lean mass, muscle strength, and functional capacity compared with normoglycemic controls [ 26 ]. Notably, when compared with matched control populations, the risk of sarcopenia increased systematically in the presence of T2D (odds ratio (OR) 1.55; 95% confidence interval (CI) 1.25–1.91; p < 0.001 [ 22 ] and OR 1.63; 95% CI 1.20–2.22; p = 0.002 [ 27 ]).…”

How to Overcome Anabolic Resistance in Dialysis-Treated Patients?

“…Patients with type 2 diabetic kidney disease often show a series of metabolic and nutritional changes linked both to diabetes and kidney failure, including insulin resistance and cardiovascular comorbidities ( 80 ), protein-energy wasting and sarcopenia ( 81 ). These patients undergo an increase in MPD, an effect primarily mediated by the ubiquitin-proteasome pathway ( 82 , 83 ). On a kinetic basis, an increase in MPD is often associated with an increase in MPS.…”