Association of type 2 diabetes mellitus with sarcopenia in adults: A meta-analysis

Type 2 diabetes mellitus (T2DM) may adversely affect skeletal muscle mass, strength, and function. We aimed to quantify associations between sarcopenia and T2DM, prediabetes, and diabetes-related complications in adults. Five databases were searched from inception to July 2026 for observational studies comparing adults with T2DM and non-diabetic controls. Two reviewers independently screened studies, extracted data, and evaluated bias. Random-effects meta-analyses estimated pooled odds ratios (ORs) with 95 % confidence intervals (CIs). Thirty-five studies were included. T2DM was associated with higher odds of sarcopenia (pooled OR 1.61, 95 % CI 1.26-2.06), despite substantial heterogeneity and a wide prediction interval. Associations were consistent across study designs, regions, and muscle-mass assessment methods, with no single study driving results or evidence of funnel-plot asymmetry. Prediabetes was not significantly associated with sarcopenia (OR 1.16, 95 % CI 0.63-2.15). Among complications, diabetic foot disease was associated with higher sarcopenia odds, whereas estimates for retinopathy, nephropathy, and neuropathy were imprecise and non-significant. Adults with T2DM have moderately higher odds of sarcopenia than non-diabetic adults, though observational design and heterogeneity limit causal claims. Muscle health assessment may benefit vulnerable adults with T2DM, but prospective studies are needed to clarify temporal associations.