Glycemic control and skeletal muscle mass: Analysis of a population-based cohort of subjects with type 2 diabetes in Peru

Background: Among subjects with type 2 diabetes mellitus (T2DM), poor glycemic control is a risk factor for complications, including loss of skeletal muscle mass (SMM). Objective: We aimed to assess the association between glycemic control and changes in muscle mass over time among T2DM subjects. Methods: Secondary data analysis of a population-based cohort involving participants aged ≥ 35 years from three regions in Peru. Participants with a self-reported diagnosis of T2DM or fasting glucose levels ≥ 126 mg/dL at baseline were included. SMM was assessed using the second version of the Lee formula at baseline and follow-up (i.e., 15 and 30 months from baseline). Glycemic control was evaluated using glycated hemoglobin (HbA1c) as controlled (< 7%) or uncontrolled (≥ 7%). Crude and adjusted linear mixed models were built, and coefficients (β) and 95% confidence intervals (95% CI) were reported. Results: Data from 259 individuals, mean age of 60.1 (SD: 10.7) years, and 144 (55.6%) females, were analyzed. At baseline, only 40.2% had controlled HbA1c, and the SMM mean was 23.4 (SD: 5.9) Kg, being lower in those uncontrolled (22.8 kg) than those controlled (24.3 kg). Over 30 months of follow-up, in multivariable model, SMM significantly decreased in the uncontrolled group at baseline, with a loss of 820 (95% CI: 350 to 1300) grams, compared to no significant change among those controlled. Conclusions: Those with uncontrolled glycemic control showed a reduction of skeletal muscle mass compared to those with controlled glycemic control. The findings underscore the importance of routine monitoring of skeletal muscle mass, alongside glycemic control, in diabetes care protocols, especially in resource-limited settings.