Sarcopenia in diabetes mellitus

Abstract

Sarcopenia is an age-related loss of skeletal muscle mass and strength. In this chapter, advances in the association of sarcopenia and diabetes mellitus are discussed. Falls in diabetic patients associate with decline of muscle mass or strength in the elderly. Insulin resistance impairs the protein regeneration in skeletal muscle and also induces the protein breakdown and muscle wasting, leading to development of sarcopenia. This insulin resistance suggests the most important linkage between sarcopenia and diabetes. Sarcopenia and obesity appear to have additive effects on insulin resistance and age-related changes in body composition. Loss of skeletal muscle mass affecting glucose disposal and impaired energy homeostasis affecting muscle protein content, together, might lead to a vicious cycle. Insulin resistance and inflammation leads to muscle wasting through the pathways involved in Akt/PKB, FoxOs, PGC-1α, and AMPK. The accumulation of AGEs through glucose intolerance enhanced by mitochondrial ROS with promotion of apoptosis leads to the development of muscle wasting. Exercise is known as the most efficient treatment of sarcopenia with diabetes but less information is known for nutritional replenishment or medications. Sarcopenia in diabetes mellitus would have higher physical dysfunction and mortality risks than those in nondiabetic older adults.