{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:33:22Z","timestamp":1777984402423,"version":"3.51.4"},"reference-count":27,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns7:p>Background Diabetic peripheral neuropathy (DPN) is associated with progressive skeletal muscle degeneration, particularly in distal lower limb muscles. Advanced imaging modalities such as CT and MRI can detect these changes; however, their routine clinical use is limited. This study aimed to evaluate the utility of quantitative musculoskeletal ultrasound for assessing lower limb muscle morphology in individuals with type 2 diabetes with and without DPN. Methods In this cross-sectional study, 215 participants were included and categorized into three groups: T2DM with DPN (n\u00a0=\u00a0129), T2DM without DPN (n\u00a0=\u00a043), and healthy controls (n\u00a0=\u00a043). DPN was assessed using the 10-g monofilament test and vibration perception threshold (VPT). Ultrasound measurements of the muscle thickness and cross-sectional area (CSA) were obtained for proximal and distal lower limb muscles using a standardized protocol. Group comparisons were performed using the Kruskal\u2013Wallis test with DSCF post-hoc analysis. Associations were assessed using Spearman\u2019s correlation. Results Quantitative ultrasound revealed that participants with DPN demonstrated significantly reduced muscle thickness and CSA across most lower limb muscles compared with both T2DM without DPN and controls (p\u00a0&lt;\u00a00.001), with the largest effect sizes observed in distal muscles, including tibialis anterior, extensor hallucis longus, extensor digitorum brevis, and abductor hallucis brevis. Ultrasound-derived muscle measurements showed significant correlations with neuropathy severity score and age. Conclusions Quantitative musculoskeletal ultrasound can be used as a feasible and sensitive imaging modality for detecting diabetes-related muscle changes in the lower limb muscles enabling early detection and monitoring of neuromuscular involvement in type 2 diabetes.<\/ns7:p>","DOI":"10.12688\/f1000research.178108.1","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T09:09:06Z","timestamp":1776676146000},"page":"488","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantitative ultrasound assessment of lower limb muscle morphology in type 2 diabetes with and without peripheral neuropathy"],"prefix":"10.12688","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2860-5100","authenticated-orcid":false,"given":"Sharath","family":"S","sequence":"first","affiliation":[{"name":"Department of Medical Imaging Technology, Manipal College of Health Professions Manipal Karnataka 576104 Manipal Academy of Higher Education"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G Arun","family":"Maiya","sequence":"additional","affiliation":[{"name":"Centre for Podiatry & Diabetic Foot Care and Research, Department of Physiotherapy, Manipal College of Health Professions Manipal Karnataka 576104 Manipal Academy of Higher Education"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3486-8740","authenticated-orcid":false,"given":"Rajagopal","family":"Kadavigere","sequence":"additional","affiliation":[{"name":"Department of Radio diagnosis and Imaging, Kasturba Medical College Manipal Karnataka 576104 Manipal Academy of Higher Education"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prakashini","family":"K","sequence":"additional","affiliation":[{"name":"Department of Radio diagnosis and Imaging, Kasturba Medical College Manipal Karnataka 576104 Manipal Academy of Higher Education"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2323-6964","authenticated-orcid":false,"given":"Shivashankar Kaniyoor","family":"Nagri","sequence":"additional","affiliation":[{"name":"Department of Medicine, Kasturba Medical College Manipal Karnataka 576104 Manipal Academy of Higher Education"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"ref1","article-title":"463 PEOPLE LIVING WITH DIABETES million.","year":"2019"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2239-2251","DOI":"10.1016\/S0140-6736(17)30058-2","article-title":"Type 2 diabetes.","volume":"389","author":"S Chatterjee","year":"2017","journal-title":"Lancet."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"S13-S27","DOI":"10.2337\/dc18-S002","article-title":"Classification and diagnosis of diabetes: Standards of medical care in Diabetes 2018.","volume":"41","author":"D Care","year":"2018","journal-title":"Diabetes Care."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1-14","DOI":"10.1186\/s12933-018-0762-4","article-title":"Association between insulin resistance and the development of cardiovascular disease.","volume":"17","author":"V Ormazabal","year":"2018","journal-title":"Cardiovasc. Diabetol."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1085-1103","DOI":"10.1016\/j.clinthera.2017.05.001","article-title":"Declining Skeletal Muscle Function in Diabetic Peripheral Neuropathy HHS Public Access Author manuscript.","volume":"39","author":"P Parasoglou","year":"2017","journal-title":"Clin. Ther."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"258-261","DOI":"10.14283\/jfa. 2018.24","article-title":"The Role of Ultrasound as a Diagnostic Tool for Sarcopenia.","volume":"7","author":"H Stringer","year":"2018","journal-title":"J. Frailty Aging."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"241-255","DOI":"10.2337\/db16-0806","article-title":"Differentiation of diabetes by pathophysiology, natural history, and prognosis.","volume":"66","author":"J Skyler","year":"2017","journal-title":"Diabetes."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"519-527","DOI":"10.18999\/nagjms. 80.4.519","article-title":"Ultrasound measurement of thigh muscle thickness for assessment of sarcopenia.","volume":"80","author":"T Hida","year":"2018","journal-title":"Nagoya J. Med. Sci."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"89-97","DOI":"10.1007\/s41999-018-0130-7","article-title":"Ultrasound assessment of rectus femoris muscle in rehabilitation patients with chronic obstructive pulmonary disease screened for sarcopenia: correlation of muscle size with quadriceps strength and fat-free mass.","volume":"10","author":"C Ram\u00edrez-Fuentes","year":"2019","journal-title":"Eur. Geriatr. Med."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/s12199-018-0710-7","article-title":"Assessment of lower extremity muscle mass, muscle strength, and exercise therapy in elderly patients with diabetes mellitus.","volume":"23","author":"T Nomura","year":"2018","journal-title":"Environ. Health Prev. Med."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1-5","DOI":"10.1186\/1880-6805-32-12","article-title":"Validity of ultrasound muscle thickness measurements for predicting leg skeletal muscle mass in healthy Japanese middle-aged and older individuals.","volume":"32","author":"Y Takai","year":"2013","journal-title":"J. Physiol. Anthropol."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"YC05-YC08","DOI":"10.7860\/JCDR\/2018\/32825.11549","article-title":"Vibration perception threshold values and clinical symptoms of diabetic peripheral neuropathy.","volume":"12","author":"A Medakkel","year":"2018","journal-title":"J. Clin. Diagn. Res."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"113-118","DOI":"10.14704\/nq. 2021.19.8.NQ21121","article-title":"The role of muscle thickness and echogenicity in the diagnosis of diabetic peripheral neuropathy.","volume":"19","author":"Z Kadhim","year":"2021","journal-title":"Neuroquantology."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"927069","DOI":"10.1155\/2014\/927069","article-title":"Early detection of atrophy of foot muscles in Chinese patients of type 2 diabetes mellitus by high-frequency ultrasonography.","volume":"2014","author":"X Wang","year":"2014","journal-title":"J. Diabetes Res."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"90","DOI":"10.3389\/fnins.2019.00090","article-title":"HbA1C Variability Is Strongly Associated With the Severity of Peripheral Neuropathy in Patients With Type 2 Diabetes.","volume":"13","author":"Y Lai","year":"2019","journal-title":"Front. Neurosci."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"770-776","DOI":"10.1016\/j.jdiacomp.2018.05.010","article-title":"Usefulness of the vibration perception thresholds measurement as a diagnostic method for diabetic peripheral neuropathy: Results from the Rio de Janeiro type 2 diabetes cohort study.","volume":"32","author":"T Santos","year":"2018","journal-title":"J. Diabetes Complicat."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"250-256","DOI":"10.2337\/diacare.24.2.250","article-title":"Simple screening test for peripheral neuropathy in the diabetes clinic.","volume":"24","author":"B Perkins","year":"2001","journal-title":"Diabetes Care."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1212\/WNL.43.4.817","article-title":"The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort.","volume":"43","author":"P Dyck","year":"1993","journal-title":"Neurology."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1543-1548","DOI":"10.2337\/diabetes.53.6.1543","article-title":"Muscle strength in type 2 diabetes.","volume":"53","author":"H Andersen","year":"2004","journal-title":"Diabetes."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"209-222","DOI":"10.1007\/s11357-009-9125-0","article-title":"Absence of insulin signalling in skeletal muscle is associated with reduced muscle mass and function: evidence for decreased protein synthesis and not increased degradation.","volume":"32","author":"E O'Neill","year":"2010","journal-title":"Age (Dordr.)."},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-s302","article-title":"Skeletal muscle insulin resistance is the primary defect in type 2 diabetes.","volume":"32","author":"R DeFronzo","year":"2009","journal-title":"Diabetes Care."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1615-1625","DOI":"10.2337\/diabetes.54.6.1615","article-title":"The pathobiology of diabetic complications: A unifying mechanism.","volume":"54","author":"M Brownlee","year":"2005","journal-title":"Diabetes."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"3053-3057","DOI":"10.2337\/dc07-0108.Additional","article-title":"Atrophy of Foot Muscles in Diabetic.","volume":"30","author":"Severinsen","year":"2007","journal-title":"Diabetes Care."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"399-407","DOI":"10.32098\/mltj. 03.2020.07","article-title":"Ultrasound tissue characteristics of diabetic muscles and tendons: Associations with strength and laboratory blood tests.","volume":"10","author":"C Kuo","year":"2020","journal-title":"Muscles Ligaments Tendons J."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"195-200","DOI":"10.5978\/islsm 15-OR-12","article-title":"Efficacy of low-level laser therapy on painful diabetic peripheral neuropathy.","volume":"24","author":"S Cg","year":"2015","journal-title":"Laser Ther."},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2016.04.011","article-title":"Premature loss of muscle mass and function in type 2 diabetes.","volume":"117","author":"M De Maza","year":"2016","journal-title":"Diabetes Res. Clin. 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