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Diabetes May Lead to an Increased Risk of Sarcopenia

Mar 20, 2021
Editor: Steve Freed, R.PH., CDE

Author: Shana Indawala, PharmD Candidate, University of South Florida Health, Taneja College of Pharmacy

Patients with type 2 diabetes may be at an increased risk of lower muscle performance and strength, putting them at risk for developing sarcopenia.  

Patients with diabetes may be at an increased risk of experiencing falls and fractures due to impaired bone architecture and microvascular complications arising from diabetes. With sarcopenia’s characterized decrease in muscle mass and muscle strength, patients with this condition may also be at a high risk of falls, fractures, and mortality. Sarcopenia affects an estimated 10% of the general population in both genders and has a higher prevalence in non-Asian populations. The correlation between diabetes mellitus and an increased risk of fractures exists. Diabetic vasculopathy and hyperglycemia may contribute to impaired muscle mass and function, leading to sarcopenia progression. However, it is unknown if the diagnosis of sarcopenia may also increase the chance of diabetes-associated fracture risk.  


The objective of this meta-analysis is to assess the relationship between sarcopenia and diabetes-associated fractures. The study’s primary outcome was to conduct a systematic review to synthesize the association between diabetes and sarcopenia risk. The secondary effect is to compare the mean values of sarcopenia between patients with diabetes and euglycemic patients. The mean values of sarcopenia included analyzing muscle mass, muscle strength, and muscle performance.  

Eligible studies were identified through PubMed, Scopus, and Cochrane. Articles included for the study had to be observational study, included patients with either type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM), and contained extractable data on the number of sarcopenia cases. Fifteen studies were included in the meta-analysis, which was published between 2012 and 2020. Seven studies in the meta-analysis were cross-sectional studies, while eight studies were case-controls. The countries in which the study was performed include Brazil, China, Italy, Japan, Mexico, Singapore, and Turkey. These fifteen studies comprised 6526 patients, of which 1832 were patients with diabetes, 4694 patients with euglycemia, and 1159 cases of sarcopenia.   

There was a range of 5 to 50% in sarcopenia prevalence in patients with T2DM. However, three studies in the meta-analysis showcased that there is a correlation between sarcopenia and hyperglycemia. Compared to euglycemic patients, patients with T2DM were at a significantly increased risk of developing sarcopenia (OR = 1.55, 95% CI: 1.25-1.91, p < 0.001). The relationship between sarcopenia indices in both patients with T2DM and euglycemic patients was also assessed. Patients with T2DM did have a lower muscle performance compared with euglycemic patients. The six studies that included data on handgrip strength found that patients with T2DM had a lower handgrip strength than euglycemic patients (standard mean difference = -0.24, 95% CI: 0.39 – 0.09, p = 0.002). A subgroup analysis was also conducted to determine the relationship between sarcopenia in patients with diabetes based on the definition of diabetes, age, sex, duration of diabetes, and HbA1c. There was an increased risk of sarcopenia when using the increased plasma glucose level at two hours (OR 1.60, 95% CI: 1.2-2.14, p = 0.001). However, the data amongst the meta-analysis studies were limited to determine the effects of any confounders and a relationship amongst the subgroups.  

This meta-analysis did showcase the correlation between the diagnosis of T2DM and the associated risk of sarcopenia. Patients with T2DM may be at an increased risk of lower muscle performance and strength, putting patients at risk of developing sarcopenia. One of the strengths of this study was the methods and studies utilized. This meta-analysis included fifteen high-quality cross-sectional and case-control studies conducted in seven countries, allowing for generalizability. Further studies are needed to determine the relationship between patients with T2DM and sarcopenia regarding age, sex, duration of diagnosis of diabetes, and HbA1c.  

Practice Pearls: 

  • Patients with diabetes should be monitored for falls and fractures during visit encounters, including frail patients and patients with comorbidities. 
  • The monitoring of muscle performance and strength should be implemented to provide holistic care when managing patients with diabetes to prevent sarcopenia progression. 
  • Patients that have hyperglycemia or diabetes that present with symptoms of sarcopenia should be recommended for resistance training or strength training exercise with the approval of a physician or a physical therapist.  


Anagnostis, Panagiotis, et al. “Type 2 Diabetes Mellitus Is Associated with Increased Risk of Sarcopenia: A Systematic Review  

Chen, Hengting, et al. “The Association between Sarcopenia and Fracture in Middle-Aged and Elderly People: A Systematic Review and Meta-Analysis of Cohort Studies.”  


Shana Indawala, PharmD Candidate, University of South Florida Health, Taneja College of Pharmacy