Malnutrition, sarcopenia and nutrition therapy for patients with diabetes - A general framework and focus on hospital care

Abstract

Background & aims: The prevalence of diabetes is increasing globally and is particularly high among hospitalized patients, presenting challenges for inpatient care. While traditional inpatient management emphasizes glycemic control, medication adjustments, and comorbidity management, malnutrition and muscle loss remain underrecognized factors that significantly influence clinical outcomes. This review aims to highlight the role of malnutrition and muscle dysfunction in hospitalized patients with diabetes and to evaluate the potential of medical nutrition therapy (MNT), particularly diabetes-specific nutrition formulas (DSNFs), to improve patient outcomes. Methods: This narrative review is based on the proceedings of a joint session between the Diabetes Nutrition Study Group (DNSG) and the European Society for Clinical Nutrition and Metabolism (ESPEN). Relevant literature was synthesized to explore the prevalence, pathophysiology, and clinical impact of malnutrition and muscle loss in diabetes, as well as the clinical applications of MNT and DSNFs in hospital and intensive care settings. Results: Malnutrition is prevalent among hospitalized patients with diabetes yet frequently goes undiagnosed, contributing to delayed recovery, increased complications, and functional decline. Muscle mass and function are now recognized as key determinants of metabolic regulation and recovery. Recent advances in diagnostic frameworks, including those developed by the Global Leadership Initiative on Malnutrition (GLIM), offer practical tools for the early identification of malnutrition and sarcopenia. Evidence supports the use of MNT, particularly DSNFs, as a strategy to support glycemic control, preserve muscle mass, and reduce complications in both general hospital and ICU settings. Conclusions: Malnutrition and muscle dysfunction are important but often overlooked components of inpatient diabetes care. Early identification using validated screening tools, coupled with timely implementation of MNT, including DSNFs, offers a promising strategy to improve metabolic management and clinical outcomes in hospitalized and critically ill patients with diabetes.