What is it about?
This review explains how diabetes accelerates muscle aging—through oxidative stress, chronic inflammation, insulin resistance, mitochondrial dysfunction, AGE accumulation, and genetics (e.g., FTO variants)—leading to sarcopenia, frailty, and functional decline. It argues that care for older adults with diabetes should treat skeletal muscle as a key target, combining exercise, nutrition, social support, and optimized medications. It also links care intensity to functional categories (based on cognition and ADL), recommending earlier, structured intervention starting at Category II.
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Why is it important?
Muscle loss drives disability: Strength declines faster than mass with age; diabetes speeds both up. Geriatric priorities shift: For adults ≥65, preventing frailty and preserving independence often matter as much as tight glycemic control. Actionable levers exist: Resistance and multicomponent exercise, adequate energy (≈30 kcal/kg/day as a common benchmark) and protein ≥1.0 g/kg/day help maintain muscle and function. Medication choices matter: Some glucose-lowering drugs may better support muscle health (e.g., metformin, DPP-4 inhibitors; cautious use of SGLT2 inhibitors in underweight/frail patients; potential atrophy signals reported with some sulfonylureas).
Perspectives
Make muscle a treatment target: Build plans around resistance training (plus aerobic work), progressed and sustained over time; results fade if exercise stops. Fuel the training: Pair exercise with enough calories and adequate protein, spread across meals; consider protein enrichment if intake is low. Match care to function: Use simple cognitive/ADL tools to classify patients (Categories I–III) and start multimodal interventions at Category II; consider de-intensifying diabetes therapy in Category III when risks outweigh benefits. Choose meds thoughtfully: Favor agents with neutral/positive muscle profiles; monitor nutrition and body composition when using weight-reducing drugs; watch for hypoglycemia that can worsen frailty. Think community & adherence: Embed exercise spaces, group programs, and social participation to keep older adults active and engaged. Research agenda: Clarify drug effects on human muscle, refine protein type/timing guidance, and test scalable multimodal programs that improve strength, mobility, and quality of life.
Prof Takuya Omura
National Center for Geriatrics and Gerontology
Read the Original
This page is a summary of: Skeletal muscle as a treatment target for older adults with diabetes mellitus: The importance of a multimodal intervention based on functional category, Geriatrics and Gerontology International, January 2022, Wiley,
DOI: 10.1111/ggi.14339.
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