Interplay between sarcopenia and type 2 diabetes: mechanisms, implications, and therapeutic prospects

Sarcopenia, characterized by the progressive loss of skeletal muscle mass and function, is both a significant risk factor for and a potential consequence of type 2 diabetes mellitus (T2D). The relationship between sarcopenia and T2D is complex and bidirectional, involving interconnected metabolic and molecular mechanisms that impair neuromuscular performance and muscle integrity during aging. The key pathways linking these conditions include insulin resistance, chronic low-grade inflammation, oxidative stress, and accumulation of advanced glycation end products. This review aims to critically examine the interplay between sarcopenia and T2D, with a focus on underlying pathophysiological mechanisms, nutritional determinants, and clinical implications. Dysregulated glucose metabolism, alterations in myostatin signaling, and activation of the ubiquitin-proteasome system are major contributors to muscle atrophy in this context. Furthermore, we highlight the role of targeted interventions, including resistance exercise, nutritional optimization, and emerging pharmacological strategies, in mitigating muscle loss and improving metabolic outcomes. A comprehensive understanding of these interconnected pathways is essential for developing integrated therapeutic approaches to improve the clinical outcomes and quality of life of affected individuals.