Sarcopenia in Diabetes: A Proposal on Integrating Muscle Assessment and Nutritional Intervention in People Living with Diabetes.

Sarcopenia is a progressive muscle disease characterized by loss of skeletal muscle mass and strength, commonly associated with ageing and chronic diseases. Type 2 diabetes mellitus (T2DM) accelerates its development through insulin resistance, chronic inflammation, oxidative stress, and hyperglycaemia. Sarcopenia may worsen diabetes-related outcomes, including increased risk of falls, functional decline, reduced quality of life, and impaired metabolic control. Despite its clinical impact, sarcopenia remains underdiagnosed in people with diabetes, particularly in those with high body mass index and excess adiposity. This paper reviews appropriate and sensitive methodologies for screening and diagnosing sarcopenia in people with diabetes. A structured expert consensus was conducted in two phases, informed by a targeted PubMed literature review and discussions with an international multidisciplinary panel. The consensus informed the development of a clinically applicable algorithm. The proposed approach integrates screening, diagnosis, staging, and management of sarcopenia, including exercise and muscle-targeted nutritional interventions, to improve clinical care. Sarcopenia is an under-recognised complication of diabetes requiring systematic assessment. This consensus provides an integrated algorithm combining functional, nutritional, and metabolic evaluation to guide personalised management.