Older adults with diabetes mellitus are susceptible to sarcopenia. Diffusion tensor imaging (DTI) studies have also indicated that patients with diabetes have altered white matter integrity. However, the relationship between these structural changes in white matter and sarcopenia remains poorly understood.
The study included 284 older patients (aged ≧65 years) who visited our Frailty Clinic. We used DTI to measure fractional anisotropy (FA) and mean diffusivity (MD) to evaluate changes in white matter integrity. We investigated the associations between sarcopenia, or its diagnostic components, and FA or MD in seven white matter tracts considered associated with sarcopenia according to the patients’ diabetic status.
We found significantly low FA or high MD values in the bilateral anterior thalamic radiations (ATR) and right inferior fronto-occipital fasciculus (rIFOF) of patients with Asian Working Group for Sarcopenia 2019-defined sarcopenia, in all patients and those with diabetes. Using binominal regression analyses, we associated low FA values in the left ATR (lATR) and rIFOF with sarcopenia in all patients and those with diabetes, after adjusting for age, gender, HbA1c, blood pressure, cognitive function, physical activity, depression, nutritional status, and inflammation.
White matter alterations in lATR and rIFOF are associated with the prevalence of sarcopenia in patients with diabetes. Specific changes to the lATR and rIFOF tracts could play critical roles in the occurrence of sarcopenia in patients with diabetes.

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