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General Endocrinology

SAT-841 - SGLT2 Inhibitors and Sarcopenic Obesity in Type 2 Diabetes: A Meta-Analysis of Lean Mass Preservation, Muscle Strength, and Functional Outcomes

Saturday, June 13, 2026
9:30 AM - 4:30 PM CT


Introduction: Type 2 diabetes mellitus (T2DM) is closely associated with sarcopenic obesity, characterized by excess adiposity and progressive decline in skeletal muscle mass and function. Sodium–glucose cotransporter 2 inhibitors (SGLT2i) have transformed T2DM management by promoting weight loss; however, concerns exist regarding potential reductions in lean body mass. It remains unclear whether these changes reflect true muscle loss or reductions in ectopic intramuscular fat, with different implications for function and outcomes.

Objective: To evaluate the impact of SGLT2 inhibitors on lean mass, muscle strength, and functional outcomes in T2DM, emphasizing the distinction between quantitative and qualitative muscle changes in sarcopenic obesity.

Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines. Studies including adults with T2DM treated with SGLT2 inhibitors versus other therapies or placebo were included. Outcomes assessed were body composition (lean and fat mass), muscle strength (handgrip), and physical performance. Data from randomized and observational studies were synthesized using a structured comparative approach, focusing on consistency in direction and magnitude of effects.

Results: SGLT2 inhibitors were consistently associated with reductions in body weight (~2.3–2.7 kg) and fat mass (~1.2–1.8 kg), including visceral fat. Changes in lean mass were variable, with some studies reporting modest reductions (~0.7–1.0 kg) and others no difference versus controls. Importantly, muscle strength was preserved (handgrip ≈ −0.3 kg, non-significant), and functional performance was maintained or improved. Evidence suggests that apparent lean mass reductions may partly reflect decreased intramuscular fat, indicating improved muscle quality rather than true loss of contractile tissue.

Conclusion: SGLT2 inhibitors promote clinically meaningful weight loss primarily via fat reduction while preserving muscle strength and function. Lean mass reductions should be interpreted cautiously, as they may reflect improved muscle composition rather than loss of contractile tissue. These findings support SGLT2 inhibitors as a metabolically effective and functionally safe strategy in T2DM and a potential adjunct in sarcopenic obesity, especially with resistance training and adequate protein intake, but not as standalone therapy. Further standardized trials are needed to clarify their role and guide personalized interventions.

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