Sarcopenia in Indian adults with type 2 diabetes: a systematic review and meta-analysis of prevalence and associated factors
Shobhit Raj, Renuka Suvarna, Girish Thunga, Varashree B S, Sahana ShettyObjectives
To determine the pooled prevalence of sarcopenia phenotypes and synthesise the evidence on factors associated with sarcopenia among adults with type 2 diabetes mellitus (T2DM) in India.
Design
Systematic review and meta-analysis.
Data sources
PubMed, Embase, Scopus and Web of Science were searched from inception to 14 January 2026, supplemented by reference list and citation searching.
Eligibility criteria for selecting studies
Cross-sectional studies of Indian adults (≥18 years) with T2DM reporting sarcopenia prevalence using Asian Working Group for Sarcopenia (AWGS) diagnostic criteria.
Data extraction and synthesis
Two reviewers independently screened and extracted data. Methodological quality was assessed using the Joanna Briggs Institute prevalence checklist. Proportions were logit-transformed and pooled using random-effects models with Hartung-Knapp CIs and prediction intervals. Associated factors were synthesised narratively within a tiered framework separating adjusted from unadjusted ORs.
Results
Seven studies (n=1359) were included. Pooled confirmed sarcopenia prevalence (AWGS 2019, k=6) was 27.4% (95% Hartung-Knapp CI 18.9% to 37.9%) but highly imprecise: I²=91.7% and the 95% prediction interval ran from 6.9% to 65.6%. Subgroup analysis showed 20.2% for dual-energy X-ray absorptiometry versus 31.7% for bioelectrical impedance analysis (Q between p=0.011). Severe sarcopenia was 11.0% (k=5) and sarcopenic obesity 25.2% (k=4); possible sarcopenia (65.6%, k=3; I²=98.6%) was too heterogeneous to interpret. In the two studies reporting adjusted estimates, hypertension (both studies) and diabetes duration ≥10 years (one study) were positively but imprecisely associated with sarcopenia. Certainty was very low for all prevalence outcomes (Grading of Recommendations Assessment, Development and Evaluation (GRADE)).
Conclusions
Sarcopenia appears common among Indian adults with T2DM, at approximately one in four, but certainty is very low and the plausible prevalence in a new cohort spans roughly 7% to 66%. These estimates are not a sufficient basis for a screening recommendation, but justify greater clinical awareness and, above all, community-based, dual-energy X-ray absorptiometry-standardised prospective studies, including from South India.
PROSPERO registration number
CRD420251251024.