Identifying A Bidirectional Relationship Between Diabetes And Sarcopenia

In the most recent issue of the European Journal of Geriatric Medicine, Veronese and colleagues published the findings of the first full methodological systematic review and meta-analysis of observational studies that examine the relationship between diabetes and sarcopenia. Sarcopenia is a degenerative loss of muscle mass and strength that is associated with aging. It is a component of a frailty diagnosis. This study found that the risk of sarcopenia increases with the presence of diabetes and conversely, that the presence of sarcopenia increases the risk of diabetes.¹

These two conditions are common in the aging population. Over 50,000 participants were included in this systematic review.¹ Interestingly, not only did those studied with diabetes show increased prevalence of sarcopenia (and vice versa), but diabetic patients with a complication showed an even higher prevalence of sarcopenia. 

I think that this study encourages us to take a step back and look at the person attached to the foot. In doing this, I think we can uniquely help identify and diagnose people who are not only frail but, even more importantly, “pre-frail,” so we can take potential steps to rehabilitate this patient. In the case of a perioperative patient, one may even consider “prehabilitation.”

Future research on this topic could have a wide-ranging impact on fall prevention, physical medicine and gait analysis. Podiatrists may want to consider adding to, or focusing on, elements of the history and physical exam that point to issues surrounding diabetes and sarcopenia. Increasing attention to more subtle findings in manual muscle testing or asking more questions about activities of daily living (ADLs) may prove illuminating. An index of suspicion for diabetes in patients with sarcopenia and vice versa may allow us to more comprehensively address these life-impacting issues. 

Dr. Armstrong is a Professor of Surgery at the Keck School of Medicine at the University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA). 

Reference:

1. Veronese N, Pizzol D, Demurtas J, et al. Association between sarcopenia and diabetes: a systematic review and meta-analysis of observational studies. Eur Geriatr Med. 2019. Available at https://doi.org/10.1007/s41999-019-00216-x. Published July 5, 2019. Accessed July 11, 2019.

Editor’s Note: This blog originally appeared at https://diabeticfootonline.com/2019/07/09/association-between-sarcopenia-and-diabetic-complications-a-systematic-review-and-meta-analysis-of-observational-studies/. It is adapted with permission from the author.