# A narrative review on the correlation between diabetic foot and sarcopenia

## TL;DR

This review explores how diabetic foot and sarcopenia are linked, worsen each other, and how managing both is crucial for better outcomes in diabetes patients.

## Contribution

The paper highlights the bidirectional relationship between diabetic foot and sarcopenia and emphasizes integrated management strategies.

## Key findings

- Sarcopenia increases the risk of diabetic foot by two to three times and leads to worse outcomes like delayed healing and amputation.
- Diabetic foot accelerates muscle atrophy through reduced mobility and disability.
- Integrated strategies like resistance training and optimized glycemic control are essential to break the cycle.

## Abstract

Diabetic foot (DF) and sarcopenia are common complications in individuals with diabetes and are linked through a bidirectional and mutually reinforcing relationship. From a pathophysiological perspective, insulin resistance disrupts skeletal muscle metabolism, while diabetic neuropathy and peripheral arterial disease compromise muscle function and mobility, increasing susceptibility to DF. Persistent low-grade inflammation further promotes muscle wasting and worsens glycemic dysregulation, establishing a self-perpetuating cycle. The presence of sarcopenia is associated with a two- to three fold increased risk of DF and is linked to poorer outcomes, including delayed wound healing and a higher likelihood of amputation. In turn, disability and reduced mobility caused by DF accelerate muscle disuse and atrophy. Integrated management strategies, encompassing resistance training, adequate protein intake, optimized glycemic control, and proactive foot care, are essential to interrupt this cycle. Although emerging pharmacological agents that enhance muscle anabolism show promise, further clinical validation is required. A multidisciplinary approach is necessary to curb the reciprocal progression of these conditions and to improve clinical outcomes in affected patients.

Infographic illustrating sarcopenia in diabetes, showing observed patient criteria, diagnostic screening, and clinical outcomes. Common risk factors listed are poor glycemic control, nutritional deficiencies, metabolic changes, and sedentary lifestyle. Potential mechanisms include chronic inflammation, oxidative stress, insulin resistance, hormonal imbalances, and neuropathy. Therapeutic strategies include lifestyle changes, omega-3 supplementation, pharmacological therapies, wound dressings, hyperbaric oxygen therapy, and advanced medical resources, visualized with relevant icons and diagrams.