The NEUROSARC-EG Study: Prevalence and Clinical Correlates of Sarcopenia in Egyptian Patients with Type 2 Diabetes and Diabetic Neuropathy – A Cross-sectional Epidemiological Study

Background and Aim: The progressive loss of strength and muscle mass, known as sarcopenia, can negatively affect a person’s metabolic health and is a syndrome that is increasingly recognized. Sarcopenia is known to be associated with type 2 diabetes mellitus (T2DM) and its complications, but data on this topic are little to none for the Egyptian demographic. The purpose of this study is to analyze the prevalence of sarcopenia and its association with the full range of diabetic neuropathy, including cardiac autonomic neuropathy (CAN), large-fiber neuropathy (LFN), and small-fiber neuropathy (SFN), as well as other cardiometabolic comorbidities in Egyptian patients with T2DM. Methods: In this cross-sectional study, data from 200 adult patients with T2DM at the diabetes and endocrinology outpatient clinic at Mansoura Specialized Medical Hospital were analyzed. A calibrated handgrip dynamometer was used to measure muscle strength, and sarcopenia was determined according to EWGSOP2 criteria from the European Working Group on Sarcopenia in Older People guidelines, using sex-specific cutoffs: <27 kg for males and <16 kg for females. CAN was evaluated with the Vagus™ CAN-504 device (JD Meditech, Germany), LFN by means of biothesiometry with a vibration perception threshold >25 mV, and SFN by Sudoscan™ (Impeto Medical, France) at an electrochemical skin conductance <70 μS. Statistical analyses were carried out using the independent samples Mann–Whitney U -test, the Chi-squared test, and binary logistic regression. Results: Sarcopenia was found in 65 of 200 patients (32.5%; 37 males and 28 females). Sarcopenic patients were older (55.5 ± 13.5 vs. 49.6 ± 13.8 years; P = 0.005), had longer diabetes duration (15.8 ± 10.9 vs. 10.1 ± 8.3 years; P < 0.001), and had a lower resting heart rate (76.5 ± 11.3 vs. 81.9 ± 11.4 bpm; P = 0.002) compared to nonsarcopenic patients. Sarcopenia was highly prevalent among all types of diabetic neuropathy: LFN (96.9% vs. 27.4%; P < 0.001), SFN (98.5% vs. 17.8%; P < 0.001), and definite CAN (90.8% vs. 12.6%; P < 0.001). Sarcopenia was also significantly associated with the presence of hypertension (100% vs. 20.7%; P < 0.001) and ischemic heart disease (63.1% vs. 0%; P < 0.001). There was no significant association between sarcopenia prevalence and BMI, glycemic control (hemoglobin A1c), or any class of antidiabetic medications. Conclusion: Sarcopenia is highly prevalent among Egyptian patients with T2DM (32.5%) and is strongly associated with all forms of diabetic neuropathy, older age, longer disease duration, and a lower resting heart rate, consistent with advanced CAN. Obesity and glycemic control did not independently predict sarcopenia in this cohort. The reported prevalence of 32.5% should be interpreted as a conservative minimum estimate, as handgrip-only assessment without muscle mass quantification systematically misclassifies early-phase sarcopenia cases as nonsarcopenic. Systematic screening for sarcopenia should be considered in diabetic patients with evidence of neuropathy or cardiovascular comorbidities, with future efforts incorporating objective muscle mass measurement.