Muscle strength and HbA1c in geriatric patients with and without diabetes: a retrospective observational cohort study

Handgrip strength (HGS) is a simple, reliable, and widely used biomarker of muscle strength and a key component in sarcopenia screening. Its potential role as an indicator of glycemic control has attracted increasing interest; however, the relationship between HGS and glycated hemoglobin (HbA1c) in older adults remains insufficiently understood, particularly in populations characterized by frailty and multimorbidity. This study aimed to explore the relationship between HGS and HbA1c levels in older adults with and without diabetes mellitus (DM) and to evaluate the potential of HGS as a clinically informative marker in the assessment of glycemic status within a comprehensive geriatric context.

In this retrospective study, 573 patients aged ≥ 60 years who underwent Comprehensive Geriatric Assessment (CGA) between May 2023 and October 2025 were included. HGS was measured using a dynamometer, and sarcopenia risk was assessed with SARC-F. Participants were stratified into sex-specific low and high HGS groups. HbA1c levels were compared across groups, and associations were examined using Spearman's correlation and multivariable linear regression analyses with stepwise adjustment for clinically relevant confounders.

The study population had a median age of 78 years, with a high prevalence of frailty (72.8%) and sarcopenia risk (81.2%). Despite generally low HGS values, individuals in the higher HGS group demonstrated higher HbA1c levels across the overall cohort and SARC-F subgroups (p < 0.05). Correlation analyses showed statistically significant but very weak positive associations between HGS and HbA1c, particularly among individuals at risk of sarcopenia. Although these associations were consistent in direction, their magnitude was limited. Regression analyses showed that this association was maintained in an adjusted model for CCI, Yesavage geriatric depression scale, three-word recall test; however, it was no longer significant in another fully adjusted model for age, BMI, diabetes status, medications, renal function, and nutritional status.

The findings indicate that there may be a weak association between HGS and glycemic status in older adults; therefore, they should be interpreted with caution. HGS may provide limited complementary information within a comprehensive geriatric assessment, particularly in frail populations, but its clinical relevance for evaluating glycemic control remains uncertain and warrants further investigation in prospective studies.