Frailty, sarcopenia, sarcopenic obesity: definitions, prevalence and consequences in type 2 diabetes

Objectives: To assess body composition, muscle function, sarcopenia, frailty, physical activity and liver elasticity in patients with type 2 diabetes (T2D). Methods: This mono-centric cross-sectional study includes adult patients with T2D attending the diabetes consultation of the Cliniques universitaires Saint-Luc from April to October 2024. Skeletal muscle is assessed by function tests, frailty scores (5-frailty phenotype, 5FP and liver frailty index, LFI) and bioimpedance. Sarcopenia is defined (geriatric EWGSOP2 society) by the association of low muscle function (handgrip strength <27kg for men and <16 kg for women or sit to stand >15sec) and myopenia (appendicular skeletal mass index <7kg/m² for men and <5.5kg/m² for women). Sarcopenic obesity (ESPEN society) is the co-existence of obesity (BMI≥30kg/m2) or adiposity (waist circumference >102cm for men and >88 cm for women) and sarcopenia defined by low muscle function (handgrip strength <27kg for men and <16kg for women or sit to stand ≥17sec) and altered body composition (increased fat mass and skeletal mass index ≤37% for men and ≤27.6% for women). Physical activity is assessed using the international physical activity questionnaire. Liver elasticity is assessed by transient elastography (Fibroscan® mini 430, Echosens, Paris, France). Results: Of the 113 patients screened, 8 were excluded (neuromuscular disorders, treatment with cortisone or methotrexate). The population was 38% female, with an average age of 62 years (± 12) and a mean body mass index (BMI) of 30 kg/m2 (± 4.9). Obesity was present in 52.4% of patients. The 5FP classified 7.6% and the LFI 8.6% of patients as frail (Fig.1A). Frail patients were older (64.0 vs. 52.7years, p<0.0001) (Fig.1B) with a more fibrous liver (6.1 vs. 5.2 kPa, p = 0.02) and a lower duration of diabetes (5 vs 24 years, p = 0.002) (Fig1C). Only 5.5% of patients were sarcopenic following the EWGSOP2 definition (Fig.1D). These were older (77 vs. 62 years, p= 0.007) (Fig.1E) but did not have significantly lower weight (74.4 vs. 88.9 kg, p = 0.08) (Fig. 1F). However, they all had a BMI <30 kg/m2. In contrast, 24.5% of patients had sarcopenic obesity following ESPEN guidelines (Fig.1D). These were not older (65.6 vs 60.2 years, p = 0.06) (Fig.1E). Interestingly, they had similar skeletal mass index (8.8 vs 8.1 kg/m2, p=0.09), appendicular skeletal mass index (8.1 vs 7.8 kg/m2, p= 0.3), physical activity (1437 vs. 1506 METs/week, p= 0.6) and the same T2D disease duration (10 vs 11 years, p=0.9). Conclusion: Frailty is present in 8% of patients and associated with liver consequences. The prevalence of sarcopenia is highly dependent on the diagnostic criteria used (geriatric or nutrition societies) due to the myopenia component. Only 5.5% of T2D patients present with sarcopenia according to EWGSOP2 definition, compared with 24.5% with the sarcopenic obesity definition by ESPEN. Identifying these two groups of patients could lead to the identification of different complications.

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Terken, C., André-Dumont, S., Henin, G., Orioli, L., & Loumaye, A. (2025). Frailty, sarcopenia, sarcopenic obesity: definitions, prevalence and consequences in type 2 diabetes. Winter symposium Obesity 2025, De Haan. https://hdl.handle.net/2078.5/273806