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Longitudinal outcomes associated with structured exercise and dietary and microbiota-targeted care in patients with
Xiaowei Huang1, Jingyu Duan2, Xue Liang1
1Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei, China.
Background:
Diabetic sarcopenia is associated with functional impairment and metabolic abnormalities in patients with type 2 diabetes mellitus (T2DM). Real-world evidence regarding structured exercise combined with dietary and microbiota-targeted care remains limited.
Methods:
This retrospective cohort study included 128 patients with T2DM and sarcopenia between January 2022 and December 2024. Based on the treatment received, patients were divided into a control group receiving conventional diabetes management (n = 63) and an intervention group receiving conventional management combined with structured exercise, dietary and microbiota-targeted care (n = 65). Outcomes were assessed at baseline and months 1, 3, 6, 9, and 12. The primary outcome was the longitudinal change in skeletal muscle index (SMI). Secondary outcomes included handgrip strength, gait speed, Short Physical Performance Battery (SPPB) score, glycated hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and homeostasis model assessment of insulin resistance (HOMA-IR), as well as the incidence of adverse events. Adjusted generalized estimating equation models were used to evaluate longitudinal trajectories.
Results:
Significant group × time interactions were observed for SMI (P = 0.017), handgrip strength (P < 0.001), gait speed (P < 0.001), and SPPB score (P = 0.015). At month 12, adjusted between-group differences favoring the intervention group were 0.282 kg/m² for SMI (95% CI, 0.177-0.387), 3.348 kg for handgrip strength (95% CI, 2.718-3.983), 0.129 m/s for gait speed (95% CI, 0.109-0.149), and 1.225 points for SPPB score (95% CI, 0.895-1.556; all P < 0.001). Group × time interactions were not significant for HbA1c, HOMA-IR, or FPG. No significant difference in adverse-event incidence was detected (Risk ratio: 1.171; P = 0.478).
Conclusions:
Structured exercise combined with dietary and microbiota-targeted care was associated with more favorable muscle-related trajectories but not superior overall glycemic control. The observational design precludes causal inference or separation of individual component effects, warranting confirmation in prospective randomized trials.