Sarcopenia and Mortality, Cardiovascular and Renal Outcomes in Type 2 Diabetes: A Systematic Review and Meta-Analysis

To systematically evaluate the associations of sarcopenia and low muscle strength with risks of all-cause mortality, cardiovascular events, and renal outcomes in patients with type 2 diabetes mellitus (T2DM).

We conducted a systematic review and meta-analysis of cohort studies by searching Embase, MEDLINE, and the Cochrane Library from inception to September 10, 2025. Eligible studies examined sarcopenia or handgrip strength in relation to mortality, cardiovascular events, or renal outcomes among adults with T2DM. Study quality was assessed using the Newcastle-Ottawa Scale. Pooled hazard ratios (HRs) were estimated using random-effects models with restricted maximum likelihood estimation and Hartung-Knapp adjustment.

A total of 21 cohort studies involving 580 277 participants were included. Sarcopenia was associated with increased risks of all-cause mortality (HR 1.70, 95% CI 1.21-2.40; I² = 44.1%) and cardiovascular events (HR 1.47, 95% CI 1.12-1.92; I² = 82.5%). For renal outcomes, the pooled estimate suggested a higher risk but did not reach statistical significance overall (HR 1.51, 95% CI 0.88-2.57; I² = 88.2%); associations were stronger and more consistent in selected subgroup and sensitivity analyses. Reduced handgrip strength showed similar upward trends in all-cause mortality and cardiovascular events, although these associations did not reach statistical significance.

Sarcopenia is associated with higher risks of all-cause mortality and adverse cardiovascular outcomes in individuals with T2DM, whereas evidence for renal outcomes remains inconclusive.