Diabetes and Sarcopenia: Intersection of Co Morbid Conditions

Sarcopenia is more common in persons with type 2 diabetes mellitus (T2DM) than in persons without diabetes. There is overlap of some pathophysiologic features of sarcopenia and T2DM. In addition, the risk for sarcopenia is associated with common complications of T2DM including renal disease, cardiovascular disease and neuropathy. Glycemic control in T2DM may have some benefits on sarcopenia. The specific effects of glucose lowering agents on sarcopenia suggest that metformin, insulin, thiazolidinediones and GLP1 receptor agonists may have favorable effects on sarcopenia while SGLT2 inhibitors may have an adverse effect. However, GLP1 RA’s and SGLT2 inhibitors have been associated with favorable effects on cardiovascular and renal outcomes and thiazolidinediones with an increased risk for heart failure. Thus glucose lowering risk/benefit ratio overall is key to selection of glucose lowering agents. Nutrition guidelines for T2DM generally align with recommendations for sarcopenia. Data on the benefits of aerobic and resistance exercise in patients with T2DM and sarcopenia is very limited, but some data suggest a benefit of resistance exercises.