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.
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.
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).
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.
Higher levels of remnant cholesterol (Rem-C) are associated with diabetic conditions, serving as a treatment target and surrogate marker for identifying high-risk groups for diabetes mellitus (DM) onset. However, the effect of Rem-C on DM onset based on sex and age remains unclear. We aimed to examine the association between Rem-C levels and DM onset, stratified by sex and age.
In this health checkup-based retrospective cohort study, we analyzed data from 13,952 participants who underwent medical checkups two or more times at the Ehime General Health Care Association between April 2003 and March 2021, a non-hospital facility where health care services are provided to company employees and local residents. The mean follow-up period was 4.66 years. Cox proportional hazard models were used to assess the association between Rem-C and DM onset.
In the multivariate analysis, higher Rem-C levels were associated with DM onset in individuals aged <50 years (men: adjusted hazard ratio [aHR] = 1.81, 95% CI: 1.46–2.20; women: aHR = 2.13, 95% CI: 1.18–3.37). However, this association was not observed in those aged ≥50 years. Triglycerides (TG) were also significantly associated with DM onset in younger adults, with slightly higher predictive ability (AUC) than Rem-C, particularly among younger women. Sensitivity analyses using continuous age as a variable showed similar trends.
Rem-C and TG may be useful predictors of DM onset in younger adults, with TG showing slightly better performance. Age-specific strategies may improve early DM prevention.
Few studies have assessed whether dynamic kidney function prior to sodium–glucose cotransporter-2 inhibitor (SGLT2i) initiation influenced subsequent renal outcomes. Thus, the study aimed to investigate whether combining estimated glomerular filtration rate (eGFR) slope and urinary albumin/creatinine ratio (UACR) change prior to using SGLT2i contributes to subsequent kidney outcomes.
This retrospective cohort study utilized data from the Kaohsiung Medical University Hospital Research Database (KMUHRD) in Taiwan. We identified 975 SGLT2i new users with type 2 diabetes from 2016 to 2020, who had an eGFR >60 mL/min/1.73 m2 and UACR <30 mg/g 1 year prior to using SGLT2i. Patients were categorized into four groups based on an eGFR decline rate of 2.5 mL/min/1.73 m2/year and a UACR increase of 30%. The primary study outcomes included a >30% eGFR decline with a drop in eGFR categories and a >43% UACR increase with progression in UACR categories.
After SGLT2i treatment, compared with the non-progressive renal function group, the glomerular injury group significantly lowered the risk of eGFR decline (adjusted hazard ratio [95% CI] 0.384 [0.199, 0.740]) and UACR progression (adjusted hazard ratio [95% CI] 0.514 [0.313, 0.846]). In addition, for those with a major eGFR decline before starting SGLT2i, significant improvements in the eGFR slope (P < 0.05) were observed after the treatment, irrespective of UACR increase.
Early initiation of SGLT2i among type 2 diabetes patients with low-risk renal disease progression and glomerular injury renal status may prevent them from progressing into chronic kidney disease.
To develop a diagnostic model of insulin-related lipohypertrophy for patients with diabetes mellitus.
A cross-sectional study was performed. Between December 2021 and November 2022, a total of 395 diabetic patients treated with insulin were enrolled from a tertiary hospital in Tianjin, China. Demographic and clinical factors were collected, and patients were assessed for lipohypertrophy by ultrasound scanning. The rate of lipohypertrophy was investigated, and a nomogram was developed based on a logistic regression model. SPSS 26.0 and R Studio 2022.12.0+353 3.6.3 were used to analyze the data.
89.6% (354/395) patients were identified with lipohypertrophy. In this study, 693 lipohypertrophy sites in lipohypertrophy patients and 91.5% (634/693) lipohypertrophy were distributed at the abdomen. Self-injection, duration of insulin injection, and incorrect rotation were selected as predictors to develop a lipohypertrophy diagnosed diagnostic nomogram model of lipohypertrophy in diabetic patients treated with insulin. The accuracy, calibration, and clinical applicability of the model are good; thus, it fits well.
A nomogram including three easily available factors (self-injection, duration of insulin injection, and incorrect rotation) was developed, and it can be used in diabetes management among diabetes patients treated with insulin.
The renoprotective effects of luseogliflozin, a sodium-glucose cotransporter 2 inhibitor, in patients with renal dysfunction are unexamined. We evaluated the efficacy of luseogliflozin in slowing renal function decline among patients with type 2 diabetes mellitus and moderate to severe renal dysfunction.
In a multicenter, randomized, open-label, controlled clinical trial, patients with type 2 diabetes mellitus and an estimated glomerular filtration rate based on serum creatinine (eGFRcreat) of 15–45 mL/min/1.73 m2 were randomized into luseogliflozin or control groups. The primary endpoint was the change in eGFRcreat from baseline to 104 weeks. Secondary endpoints included eGFRcreat and eGFRcreat slope changes from 4 to 104 weeks (chronic eGFRcreat slope).
Among 152 participants, eGFRcreat change from baseline to 104 weeks did not significantly differ between groups. The luseogliflozin group showed a significant decrease in eGFRcreat from 2 to 12 weeks compared to the control group; the largest decline occurred at 4 weeks (initial eGFR decline). There were no differences between groups thereafter. The chronic eGFRcreat slope was less negative in the luseogliflozin group compared to the control group (not significant). Conversely, subgroup analysis indicated that the difference in chronic eGFRcreat slope between groups was significantly greater (with a less negative or even positive slope observed in the luseogliflozin group compared to the control group) among patients with eGFRcreat <30 mL/min/1.73 m2, urinary albumin/creatinine ratio <30 mg/g creatinine, systolic blood pressure <130 mmHg, or females.
Although the primary endpoint did not reach statistical significance, luseogliflozin may provide renoprotective benefits in patients with type 2 diabetes mellitus and moderate-to-severe renal impairment, potentially by slowing eGFRcreat decline post-initial decline.
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