Association between sarcopenia and diabetes: a systematic review and meta-analysis of observational studies
Key summary points
To summarize the prevalence of diabetes in people with sarcopenia (and vice versa) through a meta-analytic approach of available observational studies.
In this work, we have presented the findings of the first full methodological systematic review and meta-analysis of observational studies exploring the relationship between diabetes and sarcopenia. Our findings overall emphasize the reciprocal relationship between diabetes and sarcopenia in terms of risk of occurrence, that is sarcopenia increases the risk of diabetes being present and vice versa.
This study provides support for further research into the prognosis of people with both diabetes and sarcopenia and the value of interventional strategies in sarcopenia to minimize adverse outcomes such as premature death, hospitalization, and disability.
Sarcopenia and diabetes are two common conditions in older people. Some recent literature has proposed that these two conditions can be associated. However, to date, no attempt has been made to collate this literature. Therefore, we aimed to summarize the prevalence of sarcopenia in diabetes (and vice versa) and the prevalence of sarcopenia in people with diabetes complications, through a systematic review and meta-analysis.
Two authors searched major electronic databases from inception until March 2019 for case control/cross-sectional/longitudinal studies investigating sarcopenia and diabetes. The strength of the reciprocal associations between sarcopenia and diabetes was assessed through odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for potential confounders, where possible.
From 953 potential eligible articles, 20 were included in the systematic review, with 17 providing data for meta-analysis. Overall, 54,676 participants were included (mean age = 65.4 years). Diabetic participants had an increased prevalence of sarcopenia compared to controls (n = 10; OR = 1.635; 95% CI 1.204–2.220; p = 0.002; I2 = 67%), whilst, after adjusting for potential confounders, sarcopenia was associated with an increased odds of having diabetes (OR = 2.067; 95% CI 1.396–3.624; p < 0.0001; I2 = 0%). In 1868 diabetic participants with a complication, there was an increased prevalence of sarcopenia (OR = 2.446; 95% CI 1.839–3.254; p < 0.0001; I2 = 0%), as compared with those with no complication. Very limited data existed regarding studies with a longitudinal design.
Our study suggests a bidirectional association between diabetes and sarcopenia, particularly when diabetic complications are present.
KeywordsDiabetes Sarcopenia Physical performance Meta-analysis
None to declare.
Compliance with ethical standards
Conflict of interest
The authors have not conflict of interest to declare for this work.
Not required since it is a review of already published works.
For this type of study, formal consent is not required.
- 1.Umegaki H (2016) Sarcopenia and frailty in older patients with diabetes mellitus. Geriatr Gerontol Int 16(3):293–299Google Scholar
- 2.Karjalainen M, Tiihonen M, Kautiainen H, Saltevo J, Haanpää M, Mäntyselkä P (2018) Pain and self-rated health in older people with and without type 2 diabetes. Euro Geriatr Med 9(1):127–131Google Scholar
- 3.Ogurtsova K, da Rocha Fernandes J, Huang Y, Linnenkamp U, Guariguata L, Cho N et al (2017) IDF diabetes atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract 128:40–50Google Scholar
- 4.Sinclair AJ, Abdelhafiz AH, Rodríguez-Mañas L (2017) Frailty and sarcopenia-newly emerging and high impact complications of diabetes. J Diabetes Complicat 31(9):1465–1473Google Scholar
- 7.Shafiee G, Keshtkar A, Soltani A, Ahadi Z, Larijani B, Heshmat R (2017) Prevalence of sarcopenia in the world: a systematic review and meta-analysis of general population studies. J Diabetes Metab Disord 16(1):21Google Scholar
- 8.Beaudart C, Zaaria M, Pasleau F, Reginster J-Y, Bruyère O (2017) Health outcomes of sarcopenia: a systematic review and meta-analysis. PLoS One 12(1):e0169548Google Scholar
- 9.Zhao Y, Zhang Y, Hao Q, Ge M, Dong B (2019) Sarcopenia and hospital-related outcomes in the old people: a systematic review and meta-analysis. Aging Clin Exp Res 31(1):5–14Google Scholar
- 10.Greene NP, Brown JL, Rosa-Caldwell ME, Lee DE, Blackwell TA, Washington TA (2018) Skeletal muscle insulin resistance as a precursor to diabetes: beyond glucoregulation. Curr Diabetes Rev 14(2):113–128Google Scholar
- 11.Leenders M, Verdijk LB, van der Hoeven L, Adam JJ, Van Kranenburg J, Nilwik R et al (2013) Patients with type 2 diabetes show a greater decline in muscle mass, muscle strength, and functional capacity with aging. J Am Med Dir Assoc 14(8):585–592Google Scholar
- 12.Park SW, Goodpaster BH, Strotmeyer ES, Kuller LH, Broudeau R, Kammerer C et al (2007) Accelerated loss of skeletal muscle strength in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes Care 30(6):1507–1512Google Scholar
- 13.Siviero P, Tonin P, Maggi S (2009) Functional limitations of upper limbs in older diabetic individuals. The Italian longitudinal study on aging. Aging Clin Exp Res 21(6):458–462Google Scholar
- 15.Sinclair AJ, Rodriguez-Manas L (2016) Diabetes and frailty: two converging conditions? Can J Diabetes 40(1):77–83Google Scholar
- 16.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100-e. https://doi.org/10.1371/journal.pmed.1000100 Google Scholar
- 17.Stroup DF, Ja Berlin, Morton SC, Olkin I, Williamson GD, Rennie D et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283:2008–2012. https://doi.org/10.1001/jama.283.15.2008 Google Scholar
- 19.Chen L-K, Liu L-K, Woo J, Assantachai P, Auyeung T-W, Bahyah KS et al (2014) Sarcopenia in Asia: consensus report of the Asian Working Group for sarcopenia. J Am Med Directors Assoc 15(2):95–101Google Scholar
- 20.Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M et al. The Newcastle–Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. http://www.ohrica/programs/clinical_epidemiology/oxfordasp). 2012:2012. https://doi.org/10.2307/632432
- 21.Luchini CS (2017) Brendon; solmi, marco; veronese, nicola assessing the quality of studies in meta-analyses: advantages and limitations of the Newcastle Ottawa Scale. World J Meta-Anal 5:80–84Google Scholar
- 28.Fukuda T, Bouchi R, Takeuchi T, Nakano Y, Murakami M, Minami I et al (2017) Association of diabetic retinopathy with both sarcopenia and muscle quality in patients with type 2 diabetes: a cross-sectional study. BMJ Open Diabetes Res Care 5(1):e000404. https://doi.org/10.1136/bmjdrc-2017-000404 Google Scholar
- 37.Han P, Kang L, Guo Q, Wang J, Zhang W, Shen S et al (2016) Prevalence and factors associated with Sarcopenia in suburb-dwelling older Chinese using the asian working group for Sarcopenia definition. J Gerontol Ser A Biol Sci Med Sci 71(4):529–535. https://doi.org/10.1093/gerona/glv108 Google Scholar
- 43.Srikanthan P, Hevener AL, Karlamangla AS (2010) Sarcopenia exacerbates obesity-associated insulin resistance and dysglycemia: findings from the National Health and Nutrition Examination Survey III. PLoS One 5(5):e10805Google Scholar
- 44.Moon S-S (2013) Low skeletal muscle mass is associated with insulin resistance, diabetes, and metabolic syndrome in the Korean population: the Korea national health and nutrition examination survey (KNHANES) 2009–2010. Endocr J 61(1):61–70Google Scholar
- 45.Handajani YS, Widjaja NT, Turana Y, Tengkawan J (2018) Diabetes mellitus, adl disability and nutrition intake: determination factors of severe Sarcopenia among elderly in urban nursing homes. Indian J Publ Health Res Dev 9(3):5–13Google Scholar
- 47.Cleasby ME, Jamieson PM, Atherton PJ (2016) Insulin resistance and sarcopenia: mechanistic links between common co-morbidities. J Endocrinol 229(2):R67–R81Google Scholar
- 48.Bourdel-Marchasson I, Helmer C, Fagot-Campagna A, Dehail P, Joseph PA (2007) Disability and quality of life in elderly people with diabetes. Diabetes Metab 33:S66–S74Google Scholar
- 49.Seo J, Kim S, Kim N, Baik SH, Choi DS, Choi KM (2010) Prevalence and determinant factors of Sarcopenia in patients with type 2 diabetes. Diabetes Care 33(7):1497–1499Google Scholar
- 50.Lee CG, Boyko EJ, Strotmeyer ES, Lewis CE, Cawthon PM, Hoffman AR et al (2011) Association between insulin resistance and lean mass loss and fat mass gain in older men without diabetes mellitus. J Am Geriatr Soc 59(7):1217–1224Google Scholar
- 53.Can B, Kara O, Kizilarslanoglu MC, Arik G, Aycicek GS, Sumer F et al (2017) Serum markers of inflammation and oxidative stress in Sarcopenia. Aging Clin Exp Res 29(4):745–752Google Scholar
- 54.Kirkham FA, Bunting E, Fantin F, Zamboni M, Rajkumar C (2019) Independent association between Cardio-Ankle vascular Index and Sarcopenia in older UK adults. J Am Geriatr Soc 67(2):317–322Google Scholar
- 55.Prior SJ, Ryan AS, Blumenthal JB, Watson JM, Katzel LI, Goldberg AP (2016) Sarcopenia is associated with lower skeletal muscle capillarization and exercise capacity in older adults. J Gerontol Ser A 71(8):1096–1101Google Scholar