Diabetology & Metabolic Syndrome (Aug 2025)

Dionysus or apollo, skeletal muscle mass changes in type 2 diabetes with sarcopenia receiving GLP-1 receptor agonist: systematic review and meta-analysis

  • Yanying Wang,
  • Boya Lan,
  • Shuo Zhang,
  • Yue Mu,
  • Jia Mi,
  • Jing Yu,
  • Qun Zhan,
  • Baoling Luo,
  • Fuyang Lin,
  • Jia Teng,
  • Xiuge Wang,
  • Guanchi Yan

DOI
https://doi.org/10.1186/s13098-025-01877-4
Journal volume & issue
Vol. 17, no. 1
pp. 1 – 13

Abstract

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Abstract Objective Type 2 diabetes mellitus (T2DM) increases the risk of sarcopenia, but evidence on the effects of glucagon-like peptide 1 receptor agonist (GLP-1 RA) in skeletal muscle is limited and inconsistent. The study aimed to evaluate the skeletal muscle mass of GLP-1 RA in patients with type 2 diabetes. Methods Randomized controlled trials of GLP-1 RA for sarcopenia with type 2 diabetes were identified by searching databases (up to July 6, 2025). Electronic databases (CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane library, Web of Science, and Google Scholar), grey literature (Open Grey and Proquest) and reference lists of included articles were searched. The I 2 and τ 2 statistic was used to assess the heterogeneity. The random effects model was applied regardless of the heterogeneity. Funnel plots were used to assess publication bias. The results were evaluated by calculating the risk ratio (RR), mean difference (MD), and confidence interval (CI). Results The study included nine randomized controlled trials with a total of 1089 participants. GLP-1 RA significantly reduced weight-related changes and fat-related changes, including body weight (BW) (MD= -2.25, 95%CI: -6.99 to 1.89 P = 0.20), body mass index (BMI) (MD= -1.83, 95%CI: -3.88 to 0.23, P < 0.01), fat mass (FM) (MD= -8.00, 95%CI: -11.93 to -4.08, P < 0.01), body fat ratio (BFR) (MD= -2.76, 95%CI: -3.65 to -1.87, P < 0.01), visceral fat area (VFA) (MD = 0.74, 95%CI: -54.93 to 56.40, P < 0.05). In muscle-related changes, lean body mass (LBM) (MD = 4.61, 95%CI: -4.19 to 13.42, P = 0.31), and skeletal muscle index (SMI) (MD = 0.59, 95% CI: -0.69 to 1.86, P = 0.19) were not significantly different. Conclusion GLP-1 receptor agonists, regardless of structure, have beneficial effects on body weight and fat content in type 2 diabetes with sarcopenia, but have no effect on reducing muscle mass. Registration PROSPERO (CRD42023473528).

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