Age-related decline in muscle mass, quality and function, known as sarcopenia, may make a significant but under-appreciated contribution to increasing the risk of type 2 diabetes, researchers have found.

And the presence of type 2 diabetes (T2D) appears to exacerbate progression of sarcopenia in older adults, the researchers, including Monash University Bone and Muscle Health Research Group head and head of the Department of Medicine, Professor Peter Ebeling, Postdoctoral Research Fellow Dr David Scott, and Associate Professor Barbora de Courten, from the Monash Centre for Health Research and Implementation, reported in a narrative review in the Medical Journal of Australia this week.

“As skeletal muscle is the largest insulin-sensitive tissue in the body, low muscle mass in sarcopenia likely results in reduced capacity for glucose disposal,” they explained.

“Age-related declines in muscle quality, including increased mitochondrial dysfunction and fat infiltration, are also implicated in skeletal muscle inflammation and subsequent insulin resistance. Prospective studies have shown that low muscle mass and strength are associated with increased risk of incident type 2 diabetes.

“Prevalent type 2 diabetes also appears to exacerbate progression of sarcopenia in older adults.”

Professor Ebeling told the limbic that clinicians needed to consider sarcopenia in the diabetes equation.

“I think people don’t think of muscle as being part of diabetes but sarcopenia could contribute to type 2 diabetes so we need to think about it,” he said.

He said there had historically been a focus on weight loss, diet and exercise as important factors in prevention and management of T2D.

But there has not been a great focus on weight bearing exercise and the use of weight training to maintain and increase muscle mass.

“Even a build-up of lean (muscle) mass that changes by one or two kilograms would make a huge difference,” Professor Ebeling said.

“Even light weights would be helpful and these can be done at home.”

The authors of the MJA review said recently developed operational definitions and the inclusion of sarcopenia in the International classification of diseases provided “impetus for clinicians to diagnose and treat sarcopenia in older patients.”

“Simple assessments to diagnose sarcopenia can potentially play a role in primary and secondary prevention of type 2 diabetes in older patients,” they wrote.

“Lifestyle modification programs for older adults with type 2 diabetes, particularly for those with sarcopenia, should incorporate progressive resistance training, along with adequate intakes of protein and vitamin D, which may improve both functional and metabolic health and prevent undesirable decreases in muscle mass associated with weight loss interventions.”

As some older adults with type 2 diabetes have a poor response to exercise, clinicians must ensure that lifestyle modification programs are appropriately prescribed, regularly monitored and modified if necessary, they said.

Dr David Scott has a podcast on sarcopenia and the review on MJA Podcasts 2016 Episode 42