Introduction: Previous studies demonstrated that older adults with diabetes had lower skeletal muscle mass, strength, and physical function compared with those without diabetes. The aim of this study is to evaluate the effect of hyperglycemia and insulin resistance in the progression of sarcopenia in older adults with diabetes.

Methods: The Korean Frailty and Aging Cohort Study is a multicenter prospective study with a baseline examination measured in 2016-2017. Longitudinal analysis was conducted with the 2018 follow up data. The difference of muscle related variables over the two years was evaluated for both genders and stratified by the presence of diabetes and insulin resistance.

Results: Among the 1,515 participants with baseline and two-year follow-up examination on skeletal muscle mass, strength, and function, 327 (21.6%) had diabetes mellitus at baseline. Participants showed decline in ASM, ASM/height2, ASM/body mass index (BMI), gait speed, and Timed Up and Go (TUG) test regardless of diabetes status over the two years (all p<0.001). In men with higher HOMA-IR (≥1.11), the decline of muscle mass indices (p<0.001), and TUG test (p=0.002) was significantly greater than men with lower HOMA-IR (<1.11). Women with higher HOMA-IR also showed greater decline in hand grip strength (p=0.040) gait speed (p=0.035), muscle mass indices (p<0.005), and TUG test (p=0.010) than women with lower HOMA-IR. None of the variables were significantly different when compared according to the baseline HbA1c level. In subjects without diabetes, the decline of muscle mass indices was significantly greater in subjects with higher HOMA-IR compared to those with lower HOMA-IR, but muscle strength and function were not affected by insulin resistance.

Conclusion: Insulin resistance shows preponderating influence over hyperglycemia in progression of sarcopenia in Korean older adults. This result suggests that insulin sensitizer might be beneficial in prevention of sarcopenia in older adults with diabetes.


H. Choe: None. K. Kim: None. T. Oh: None. S. Choi: None. K. Park: None. H. Jang: Speaker’s Bureau; Self; Daiichi Sankyo, Handok, Pfizer Inc., Takeda Pharmaceutical Company Limited.

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