How common is sarcopenia (loss of muscle) in people with type 2 diabetes - and what can we do about it?

To pin down exactly how common sarcopenia is, is challenging, because doctors are often not looking for it, and because accurate assessment of muscle mass is challenging. Most studies looking at body composition use DEXA scans or bioelectrical impedence analysis, which are not very accurate [MRI or CT scan give more accurate results, but these are expensive, have very limited (if any) availability, and CT scans also have radiation exposure as a downside].

Importantly, sarcopenia is not just about how much muscle there is, but more importantly, how that muscle is functioning. This can be assessed with the chair sit-to-stand test, grip strength, and various functional/walking tests.

A systematic review and meta-analysis of studies using DEXA or bioimpedance found that about 27% of people with diabetes have sarcopenia. Note that people with obesity (with or without diabetes) are at risk of sarcopenia.

A recent Call To Action from the European Society for Clinical Nutrition and Metabolism and the Diabetes Nutrition Study group recommends enhanced awareness about sarcopenia, stimulation of research, and promoting a consensus on how to make the diagnosis of sarcopenia in people with diabetes, how to prevent it, and how to treat it.

So for people living with type 2 diabetes and their health care professionals, what does this actually mean?

First, screen for sarcopenia. Check out my prior blog on how to do this. If we are not thinking about sarcopenia and screening for it, we will not find it.

For prevention and treatment,

ensuring adequate nutrition (including adequate protein and micronutrients)
physical activity (resistance and weight bearing) – send those muscles the signals to build!
be especially attentive to screening for sarcopenia before and during weight loss journeys . When we lose weight , we lose about 1/3 as muscle and 2/3 as fat. So it’s especially important to prevent and manage it with the strategies above. And, if sarcopenia develops on a weight loss journey, the dose of the weight reducing medication should be decreased, or in some cases, may need to be stopped.

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