The impact of sarcopenia on clinical outcomes in patients with diabetes: A systematic review and meta-analysis of cohort studies.

Abstract

To evaluate the impact of sarcopenia on clinical outcomes in patients with diabetes through systematic review and meta-analysis. A systematic search across nine English and Chinese databases until December 10, 2025, identified eligible cohort studies. Two investigators independently screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale. A random-effects model was employed for the meta-analysis of primary outcomes. Secondary outcomes were summarized descriptively. Seventeen cohort studies, involving a combined cohort of 471,986 patients with diabetes, were included. Meta-analysis showed that sarcopenia significantly increased the risk of all-cause mortality (HR = 1.95, 95% CI: 1.40-2.73), cardiovascular disease (HR = 1.65, 95% CI: 1.01-2.68), and hospital readmission (OR = 2.20, 95% CI: 1.05-4.61) in this population. Subgroup analysis indicated a higher mortality risk among older patients (HR = 2.39). The descriptive synthesis indicated that sarcopenia was also associated with an increased risk of diabetic kidney disease, disability, cognitive decline, depressive symptoms, fragility fractures, and sleep disorders. Sarcopenia is a significant risk factor for multiple adverse clinical outcomes in patients with diabetes. These findings support the role of sarcopenia as a prognostic marker for risk stratification in diabetes management.