Additive impact of diabetes and sarcopenia on all-cause and cardiovascular mortality: A longitudinal nationwide population-based study

Objective: Diabetes mellitus (DM) and sarcopenia (SP) are growing public health concerns in an aging society, which share common pathophysiological mechanisms and are associated with serious health consequences. We investigated the impact of DM and SP on all-cause and cardiovascular mortalities in a longitudinal nationwide population-based study. Methods: The study analyzed data from the Korea National Health and Nutrition Examination Survey conducted between 2008 and 2011, including information on appendicular skeletal muscle mass data. Mortality data up to December 2020 were retrieved from the National Death Registry. Results: Among the 17,920 participants, 14,737 (82.2 %) had neither DM nor SP (DM−/SP−), 1349 (7.5 %) had only DM (DM+/SP−), 1425 (8.0 %) had only SP (DM−/SP+), and 409 (2.3 %) had both DM and SP (DM+/SP+). Compared to the DM−/SP− group, the DM−/SP+ and DM+/SP+ groups demonstrated increased all-cause mortality with adjusted hazard ratios (HRs) of 1.47 (95 % confidence interval [CI]: 1.14–1.89) and 1.85 (95 % CI: 1.28–2.69), respectively, while the DM+/SP− group did not (HR 1.29, 95 % CI: 0.97–1.74). The DM+/SP+ group demonstrated the highest risk of overall mortality (p-for-trend <0.001). Compared to the DM–/SP– group, only the DM+/SP+ group demonstrated increased cardiovascular mortality with HRs of 2.10 (95 % CI: 1.11–4.00) while the DM+/SP− (HR 1.35, 95 % CI: 0.79–2.30) and DM−/SP+ (HR 1.42, 95 % CI: 0.84–2.43) groups did not. Conclusions: The coexistence of DM and SP additively increased the risk of all-cause and cardiovascular mortality. Individuals with either disease may require more careful management to prevent the development of the other disease to reduce mortality.