Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.
Diabetes Metab J. 2023 Nov;47(6):719-742. doi: 10.4093/dmj.2023.0112. Epub 2023 Sep 14.
Type 2 diabetes mellitus (T2DM) and sarcopenia (low skeletal muscle mass and function) share a bidirectional relationship. The prevalence of these diseases increases with age and they share common risk factors. Skeletal muscle fat infiltration, commonly referred to as myosteatosis, may be a major contributor to both T2DM and sarcopenia in older adults via independent effects on insulin resistance and muscle health. Many strategies to manage T2DM result in energy restriction and subsequent weight loss, and this can lead to significant declines in muscle mass in the absence of resistance exercise, which is also a first-line treatment for sarcopenia. In this review, we highlight recent evidence on established treatments and emerging therapies targeting weight loss and muscle mass and function improvements in older adults with, or at risk of, T2DM and/or sarcopenia. This includes dietary, physical activity and exercise interventions, new generation incretin-based agonists and myostatin-based antagonists, and endoscopic bariatric therapies. We also highlight how digital health technologies and health literacy interventions can increase uptake of, and adherence to, established and emerging treatments and therapies in older adults with T2DM and/or sarcopenia.
2 型糖尿病（T2DM）和肌肉减少症（低骨骼肌量和功能）呈双向关系。这些疾病的患病率随着年龄的增长而增加，且它们具有共同的危险因素。骨骼肌脂肪浸润，通常称为肌少脂病，可能通过对胰岛素抵抗和肌肉健康的独立影响，成为导致老年人 T2DM 和肌肉减少症的主要因素。许多用于管理 T2DM 的策略会导致能量限制和随后的体重减轻，如果没有进行阻力运动，这可能会导致肌肉量显著下降，而阻力运动也是肌肉减少症的一线治疗方法。在这篇综述中，我们重点介绍了针对患有或有风险的 T2DM 和/或肌肉减少症的老年人的体重减轻以及肌肉质量和功能改善的现有治疗方法和新兴治疗方法的最新证据。这些方法包括饮食、身体活动和运动干预、新一代基于肠促胰岛素的激动剂和基于肌肉生长抑制素的拮抗剂，以及内镜减重治疗。我们还重点介绍了数字健康技术和健康素养干预措施如何提高患有 T2DM 和/或肌肉减少症的老年人对现有和新兴治疗方法和疗法的接受度和依从性。
