Journal of diabetes and its complications · 2026
Impact of the AWGS2025 criteria on sarcopenia prevalence and microvascular complications in individuals with type 2 diabetes in Japan: a cross-sectional study.
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Hashimoto Yoshitaka, Yamamoto Shinta, Takahashi Fuyuko, Murai Moe, Yoshioka Nozomi, Saijyo Yuto, Munekawa Chihiro, Nakajima Hanako, Kitagawa Noriyuki, Osaka Takafumi, Sakai Ryosuke, Okada Hiroshi, Nakanishi Naoko, Majima Saori, Ushigome Emi, Hamaguchi Masahide, Fukui Michiaki
Аннотация
BACKGROUND: Sarcopenia is one of the causes of disability and complications in individuals with type 2 diabetes (T2D). The Asian Working Group for Sarcopenia (AWGS) updated its diagnostic criteria in 2025, but the clinical implications of this revision remain unclear.
METHODS: We analyzed 754 Japanese individuals with T2D from the KAMOGAWA-A cohort. Handgrip strength, skeletal muscle mass index (SMI), and appendicular skeletal muscle mass adjusted for BMI (ASM/BMI) were assessed. Sarcopenia was defined according to AWGS 2019 and AWGS 2025 criteria. Associations with diabetic retinopathy, nephropathy, and neuropathy were examined using logistic regression and proportional odds models.
FINDINGS: Sarcopenia prevalence increased from 15.0% under AWGS 2019 to 23.6% under AWGS 2025. Newly identified cases were predominantly individuals aged <65 years or with BMI ≥23 kg/m2 who met the low ASM/BMI criterion. Sarcopenia defined by both criteria was significantly associated with diabetic nephropathy even after adjusting for covariates (odds ratio: 2.25 (95% confidence interval1.31-3.88) in AWGS2019 and 1.78 (1.17-2.70) in AWGS2025). Associations with neuropathy and retinopathy were attenuated after adjustment for covariates.
INTERPRETATION: Adoption of the AWGS 2025 criteria substantially increases the estimated prevalence of sarcopenia in Japanese individuals with T2D, especially in younger and higher-BMI individuals. Sarcopenia remains strongly associated with diabetic nephropathy regardless of diagnostic definition. These findings highlight the need to reconsider screening strategies and resource allocation for sarcopenia management in the Western Pacific region.
METHODS: We analyzed 754 Japanese individuals with T2D from the KAMOGAWA-A cohort. Handgrip strength, skeletal muscle mass index (SMI), and appendicular skeletal muscle mass adjusted for BMI (ASM/BMI) were assessed. Sarcopenia was defined according to AWGS 2019 and AWGS 2025 criteria. Associations with diabetic retinopathy, nephropathy, and neuropathy were examined using logistic regression and proportional odds models.
FINDINGS: Sarcopenia prevalence increased from 15.0% under AWGS 2019 to 23.6% under AWGS 2025. Newly identified cases were predominantly individuals aged <65 years or with BMI ≥23 kg/m2 who met the low ASM/BMI criterion. Sarcopenia defined by both criteria was significantly associated with diabetic nephropathy even after adjusting for covariates (odds ratio: 2.25 (95% confidence interval1.31-3.88) in AWGS2019 and 1.78 (1.17-2.70) in AWGS2025). Associations with neuropathy and retinopathy were attenuated after adjustment for covariates.
INTERPRETATION: Adoption of the AWGS 2025 criteria substantially increases the estimated prevalence of sarcopenia in Japanese individuals with T2D, especially in younger and higher-BMI individuals. Sarcopenia remains strongly associated with diabetic nephropathy regardless of diagnostic definition. These findings highlight the need to reconsider screening strategies and resource allocation for sarcopenia management in the Western Pacific region.