Sarcopenia in type 2 Diabetes mellitus among Asian populations: prevalence and risk factors based on AWGS- 2019: a systematic review and meta-analysis.

Abstract

Background: Sarcopenia is increasingly recognized as a significant complication in type 2 diabetes mellitus (T2DM), yet its prevalence and risk factors in Asian populations remain incompletely understood using the updated Asian Working Group for Sarcopenia (AWGS) 2019 criteria. The present review aimed to evaluate the prevalence of sarcopenia among Asian T2DM patients and identify associated risk factors using AWGS-2019 criteria through systematic review and meta-analysis.

Methods: A comprehensive systematic review of PubMed, SCOPUS, Crossref, Google Scholar, Semantic Scholar, and OpenAlex followed PRISMA guidelines to identify observational studies assessing the magnitude of sarcopenia in type-2 Diabetes mellitus. Random-effect models were used to estimate pooled prevalence and odds ratios (OR) for associated factors. Heterogeneity was quantified using I² statistics and Cochran's Q test, where I² values of 25%, 50%, and 75% indicated low, moderate, and high heterogeneity, respectively. Subgroup analyses and meta-regression explored heterogeneity sources across all studies. The quality of the studies was assessed by the Joanna Briggs Institute (JBI) criteria. Publication bias was assessed by funnel plot and Egger's test.

Findings: Thirty nine studies, including approximately 19,902 participants, were analyzed. The pooled prevalence of confirmed sarcopenia was 23% (95% CI: 18%-27%, p < 0.001) among Asian T2DM patients, with notably higher rates of possible sarcopenia at 61% (95% CI: 28%-86%, p < 0.001) and lower rates of severe sarcopenia at 12.1% (95% CI: 8.4%-16.7%, p < 0.001). Regional variations showed a higher prevalence in Southeast Asia (37.46%) compared to Western Pacific (21.95%). Meta-analysis revealed significant risk factors including older age (OR: 1.13, 95% CI: 1.11-1.16, p < 0.0001), male gender (OR: 2.37, 95% CI: 1.33-4.21, p = 0.0033), hypertension (OR: 3.65, 95% CI: 1.06-12.65, p = 0.0409), diabetes duration (OR: 1.35, 95% CI: 1.05-2.13, p = 0.02), and reduced physical activity (OR: 2.54, 95% CI: 1.92-3.36, p < 0.0001). Higher BMI (OR: 0.63, 95% CI: 0.53-0.75, p < 0.0001) and better vitamin D levels (OR: 0.91, 95% CI: 0.87-0.95, p < 0.001) demonstrated protective effects. Recent studies (2023-2024) showed a higher prevalence than pre-2022 studies (27.85% vs 18.42%, p = 0.0440). DXA-based measurements yielded higher prevalence estimates than BIA-based assessments (29.86% vs 19.52%, p = 0.7121).

Interpretation: Sarcopenia affects nearly one-quarter of Asian T2DM patients, with significant regional variations. Age, male gender, hypertension, and physical inactivity were key risk factors, while maintaining a healthy BMI and good nutrition appeared protective. These findings emphasize the importance of regular screening and early intervention strategies, particularly for high-risk patients.