Prevalence and risk factors of sarcopenia in Asian adults with type 2 diabetes

Aims/Introduction: Middle-aged and elderly individuals in Asia with type 2 diabetes mellitus have an increased risk of developing sarcopenia. This systematic review and meta-analysis aimed to estimate sarcopenia prevalence and identify key risk factors among middle-aged and elderly type 2 diabetes mellitus persons in Asia. Materials and Methods: We searched PubMed, Embase, Cochrane Library, Web of Science, and CINAHL up to August 2025. Observational studies on persons aged ≥45 with type 2 diabetes mellitus reporting sarcopenia prevalence and risk factors were included. Quality was assessed using the Newcastle–Ottawa Scale, and random-effects models calculated pooled estimates. Results: A total of 43 studies with sarcopenia prevalence in type 2 diabetes mellitus ranging from 4.0% to 50.0% were included. The pooled prevalence among individuals with type 2 diabetes mellitus was 17 (14–21%), 13 (8–18%), and 17% (14–21%) for overall, middle-aged, and elderly individuals, respectively, with no significant difference between the middle-aged and elderly individuals. Sarcopenia was higher in Southeast Asia (28%). Key risk factors included advanced age (OR = 1.12), elevated HbA1c (OR = 1.11), diabetes-related complications (nephropathy OR = 1.76 and neuropathy OR = 3.28), and a higher body fat percentage in men (OR = 1.26) and women (OR = 1.27). In contrast, protective factors included a higher BMI (OR = 0.66), a better Mini Nutritional Assessment score (OR = 0.37), and the use of metformin (OR = 0.26). Conclusions: Sarcopenia is common in middle-aged and older Asian adults with type 2 diabetes mellitus. Interventions targeting glycemic control, complications, body composition, nutrition, and metformin may help reduce risk. This study highlights the importance of early sarcopenia screening and prevention, especially in middle-aged individuals with type 2 diabetes mellitus. Further studies are needed to establish causal relationships for prevention.