{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T20:45:26Z","timestamp":1791924326555,"version":"4.3.4"},"reference-count":70,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Clin. Pract.","Clinics and Practice"],"abstract":"<jats:p>Background\/Objectives: In obesity-associated type 2 diabetes (T2DM), therapeutic benefit increasingly requires assessment of not only HbA1c and total body weight, but also the composition and functional quality of weight change. We evaluated a myoprotective fat-loss phenotype, defined as a reduction in adiposity accompanied by preservation of lean mass and handgrip strength. Methods: This secondary patient-level analysis included 166 adults with T2DM who completed 12 months of follow-up without changing treatment in a real-world tertiary diabetes cohort. Patients received metformin alone or metformin combined with a sulfonylurea, a DPP-4 inhibitor, an SGLT2 inhibitor, a GLP-1 receptor agonist, or insulin. Body composition was assessed by bioimpedance and muscle function by handgrip dynamometry. The primary phenotype required a reduction in fat mass \u22655%, a loss of lean mass &lt;3%, and a decrease in handgrip \u22641 kg. Phenotype distributions were compared between treatment groups; patient-level associations and adjusted contrasts were explored using correlation analyses and baseline-adjusted regression models with robust HC3 standard errors. Results: Fat-mass reduction \u22655% occurred in 58\/166 patients (34.9%), lean-mass preservation in 129\/166 (77.7%), and handgrip preservation in 143\/166 (86.1%). The complete myoprotective phenotype was present in 35\/166 patients (21.1%) and differed significantly across treatment groups (\u03c72 = 131.58; permutation p &lt; 0.0001). It was most frequent in the GLP-1 receptor agonist group (13\/23; 56.5%) and the SGLT2 inhibitor group (12\/25; 48.0%), less frequent with metformin monotherapy (9\/46; 19.6%) and DPP-4 inhibitors (1\/17; 5.9%), and absent in the sulfonylurea and insulin groups. GLP-1 receptor agonists showed the greatest crude fat-mass loss, whereas lean-mass loss, skeletal-muscle-mass change, and handgrip change did not differ significantly across groups after false-discovery-rate correction. Conclusions: Myoprotective fat-loss phenotypes can be identified in obesity-associated T2DM using body composition and handgrip measures. These observational findings support the assessment of the quality, not just the magnitude, of weight loss in diabetes care and require validation in larger prospective studies.<\/jats:p>","DOI":"10.3390\/clinpract16080141","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T11:45:26Z","timestamp":1785239126000},"page":"141","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Myoprotective Fat-Loss Phenotypes in Obesity-Associated Type 2 Diabetes: A 12-Month Real-World Cohort Study of Metformin-Based Treatment Regimens"],"prefix":"10.3390","volume":"16","author":[{"given":"Ioana","family":"Bujdei-Tebeic\u0103","sequence":"first","affiliation":[{"name":"Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"given":"Anca Mihaela","family":"Pantea-Stoian","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"National Institute of Diabetes, Nutrition and Metabolic Diseases N.C. Paulescu, 020475 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Doina Andrada","family":"Mihai","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"National Institute of Diabetes, Nutrition and Metabolic Diseases N.C. Paulescu, 020475 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Simona Diana","family":"\u0218tefan","sequence":"additional","affiliation":[{"name":"National Institute of Diabetes, Nutrition and Metabolic Diseases N.C. Paulescu, 020475 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Cristian","family":"Serafinceanu","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"National Institute of Diabetes, Nutrition and Metabolic Diseases N.C. Paulescu, 020475 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1136\/bmj.321.7258.405","article-title":"Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): Prospective observational study","volume":"321","author":"Stratton","year":"2000","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2753","DOI":"10.2337\/dci22-0034","article-title":"Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)","volume":"45","author":"Davies","year":"2022","journal-title":"Diabetes Care"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S181","DOI":"10.37765\/ajmc.2024.89670","article-title":"An overview of cardiovascular-kidney-metabolic syndrome","volume":"30","author":"Ferdinand","year":"2024","journal-title":"Am. J. Manag. Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"C375","DOI":"10.1152\/ajpcell.00379.2020","article-title":"Adipose tissue inflammation and metabolic dysfunction in obesity","volume":"320","author":"Kawai","year":"2021","journal-title":"Am. J. Physiol. Cell Physiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2403","DOI":"10.1016\/j.apsb.2023.01.012","article-title":"Pathophysiology of obesity and its associated diseases","volume":"13","author":"Jin","year":"2023","journal-title":"Acta Pharm. Sin. B"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"130","DOI":"10.4239\/wjd.v14.i3.130","article-title":"Pancreatic \u03b2-cell dysfunction in type 2 diabetes: Implications of inflammation and oxidative stress","volume":"14","author":"Dludla","year":"2023","journal-title":"World J. Diabetes"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1016\/j.eprac.2022.08.002","article-title":"American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update","volume":"28","author":"Blonde","year":"2022","journal-title":"Endocr. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee for Diabetes (2026). 8. Obesity and Weight Management for the Prevention and Treatment of Diabetes: Standards of Care in Diabetes-2026. Diabetes Care, 49, S166\u2013S182.","DOI":"10.2337\/dc26-S008"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Holmes, C.J., and Racette, S.B. (2021). The Utility of Body Composition Assessment in Nutrition and Clinical Practice: An Overview of Current Methodology. Nutrients, 13.","DOI":"10.3390\/nu13082493"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"156113","DOI":"10.1016\/j.metabol.2024.156113","article-title":"Effect of glucagon-like peptide-1 receptor agonists and co-agonists on body composition: Systematic review and network meta-analysis","volume":"164","author":"Karakasis","year":"2025","journal-title":"Metabolism"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2720","DOI":"10.1111\/dom.16275","article-title":"Body composition changes during weight reduction with tirzepatide in the SURMOUNT-1 study of adults with obesity or overweight","volume":"27","author":"Look","year":"2025","journal-title":"Diabetes Obes. Metab."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s12933-020-01197-z","article-title":"Cardiovascular and renal outcomes with SGLT-2 inhibitors versus GLP-1 receptor agonists in patients with type 2 diabetes mellitus and chronic kidney disease: A systematic review and network meta-analysis","volume":"20","author":"Yamada","year":"2021","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"177885","DOI":"10.1016\/j.ejphar.2025.177885","article-title":"The effects of GLP-1 receptor agonists on body composition in patients with type 2 diabetes, overweight or obesity: A meta-analysis of randomized controlled trials","volume":"1003","author":"Lu","year":"2025","journal-title":"Eur. J. Pharmacol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Pan, R., Zhang, Y., Wang, R., Xu, Y., Ji, H., and Zhao, Y. (2022). Effect of SGLT-2 inhibitors on body composition in patients with type 2 diabetes mellitus: A meta-analysis of randomized controlled trials. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0279889"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1002\/j.2040-4603.2020.tb00136.x","article-title":"Role of Skeletal Muscle in Insulin Resistance and Glucose Uptake","volume":"10","author":"Merz","year":"2020","journal-title":"Compr. Physiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.2147\/DMSO.S186600","article-title":"Sarcopenia and type 2 diabetes mellitus: A bidirectional relationship","volume":"12","author":"Mesinovic","year":"2019","journal-title":"Diabetes Metab. Syndr. Obes."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Izzo, A., Massimino, E., Riccardi, G., and Della Pepa, G. (2021). A Narrative Review on Sarcopenia in Type 2 Diabetes Mellitus: Prevalence and Associated Factors. Nutrients, 13.","DOI":"10.3390\/nu13010183"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"719","DOI":"10.4093\/dmj.2023.0112","article-title":"Type 2 Diabetes Mellitus and Sarcopenia as Comorbid Chronic Diseases in Older Adults: Established and Emerging Treatments and Therapies","volume":"47","author":"Mesinovic","year":"2023","journal-title":"Diabetes Metab. J."},{"key":"ref_19","first-page":"339","article-title":"Sarcopenic obesity and weight loss-induced muscle mass loss","volume":"28","author":"Caturano","year":"2025","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.2337\/dbi25-0003","article-title":"High-Quality Weight Loss in Obesity: Importance of Skeletal Muscle","volume":"74","author":"Harper","year":"2025","journal-title":"Diabetes"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"511","DOI":"10.3945\/an.116.014506","article-title":"Preserving Healthy Muscle during Weight Loss","volume":"8","author":"Cava","year":"2017","journal-title":"Adv. Nutr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e12683","DOI":"10.1111\/cob.12683","article-title":"Preservation of healthy lean body mass and function during weight loss","volume":"14","author":"Wilkinson","year":"2024","journal-title":"Clin. Obes."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"McCarthy, D., and Berg, A. (2021). Weight Loss Strategies and the Risk of Skeletal Muscle Mass Loss. Nutrients, 13.","DOI":"10.3390\/nu13072473"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1016\/j.clnu.2004.06.004","article-title":"Bioelectrical impedance analysis\u2014Part I: Review of principles and methods","volume":"23","author":"Kyle","year":"2004","journal-title":"Clin. Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Sbrignadello, S., G\u00f6bl, C., and Tura, A. (2022). Bioelectrical Impedance Analysis for the Assessment of Body Composition in Sarcopenia and Type 2 Diabetes. Nutrients, 14.","DOI":"10.3390\/nu14091864"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1038\/s41387-022-00223-1","article-title":"Validation of a multi-frequency bioelectrical impedance analysis device for the assessment of body composition in older adults with type 2 diabetes","volume":"12","author":"Buch","year":"2022","journal-title":"Nutr. Diabetes"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: Revised European consensus on definition and diagnosis","volume":"48","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.1007\/s00125-025-06448-w","article-title":"Heterogeneity in response to GLP-1 receptor agonists in type 2 diabetes in real-world clinical practice: Insights from the DPV register\u2014An IMI-SOPHIA study","volume":"68","author":"Heni","year":"2025","journal-title":"Diabetologia"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1038\/s43856-023-00359-w","article-title":"Treatment effect heterogeneity following type 2 diabetes treatment with GLP1-receptor agonists and SGLT2-inhibitors: A systematic review","volume":"3","author":"Young","year":"2023","journal-title":"Commun. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.2337\/dbi20-0002","article-title":"Precision Medicine in Type 2 Diabetes: Using Individualized Prediction Models to Optimize Selection of Treatment","volume":"69","author":"Dennis","year":"2020","journal-title":"Diabetes"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1038\/s43856-023-00360-3","article-title":"Precision subclassification of type 2 diabetes: A systematic review","volume":"3","author":"Misra","year":"2023","journal-title":"Commun. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2293","DOI":"10.1056\/NEJMsb1609216","article-title":"Real-World Evidence\u2014What Is It and What Can It Tell Us?","volume":"375","author":"Sherman","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Hanlon, P., Hannigan, L., Rodriguez-Perez, J., Fischbacher, C., Welton, N.J., Dias, S., Mair, F.S., Guthrie, B., Wild, S., and McAllister, D.A. (2019). Representation of people with comorbidity and multimorbidity in clinical trials of novel drug therapies: An individual-level participant data analysis. BMC Med., 17.","DOI":"10.1186\/s12916-019-1427-1"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1111\/1753-0407.12297","article-title":"Prevalence of diabetes mellitus and prediabetes in the adult Romanian population: PREDATORR study","volume":"8","author":"Mota","year":"2016","journal-title":"J. Diabetes"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1186\/s12933-017-0622-7","article-title":"Translating recent results from the Cardiovascular Outcomes Trials into clinical practice: Recommendations from the Central and Eastern European Diabetes Expert Group (CEEDEG)","volume":"16","author":"Schernthaner","year":"2017","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"147","author":"Altman","year":"2007","journal-title":"Ann. Intern. Med."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Sousa-Santos, A.R., and Amaral, T.F. (2017). Differences in handgrip strength protocols to identify sarcopenia and frailty\u2014A systematic review. BMC Geriatr., 17.","DOI":"10.1186\/s12877-017-0625-y"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1007\/BF00280883","article-title":"Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man","volume":"28","author":"Matthews","year":"1985","journal-title":"Diabetologia"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"81","DOI":"10.14740\/jocmr5096","article-title":"The Association Between Lean-to-Fat Mass Ratio and Cardiometabolic Abnormalities: An Analytical Cross-Sectional Study","volume":"16","author":"Barengo","year":"2024","journal-title":"J. Clin. Med. Res."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Chun, S.W., Kim, W., and Choi, K.H. (2019). Comparison between grip strength and grip strength divided by body weight in their relationship with metabolic syndrome and quality of life in the elderly. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0222040"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"8","DOI":"10.4097\/kjae.2016.69.1.8","article-title":"Nonparametric statistical tests for the continuous data: The basic concept and the practical use","volume":"69","author":"Nahm","year":"2016","journal-title":"Korean J. Anesthesiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1136\/bmj.323.7321.1123","article-title":"Statistics notes: Analysing controlled trials with baseline and follow up measurements","volume":"323","author":"Vickers","year":"2001","journal-title":"BMJ"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"709","DOI":"10.3758\/BF03192961","article-title":"Using heteroskedasticity-consistent standard error estimators in OLS regression: An introduction and software implementation","volume":"39","author":"Hayes","year":"2007","journal-title":"Behav. Res. Methods."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/S0166-4328(01)00297-2","article-title":"Controlling the false discovery rate in behavior genetics research","volume":"125","author":"Benjamini","year":"2001","journal-title":"Behav. Brain Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/S0140-6736(21)01919-X","article-title":"Obesity management as a primary treatment goal for type 2 diabetes: Time to reframe the conversation","volume":"399","author":"Lingvay","year":"2022","journal-title":"Lancet"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s11892-023-01522-2","article-title":"Sarcopenic Obesity and Cardiometabolic Health and Mortality in Older Adults: A Growing Health Concern in an Ageing Population","volume":"23","author":"Wannamethee","year":"2023","journal-title":"Curr. Diabetes Rep."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1093\/gerona\/glab240","article-title":"Weight Loss and Exercise Differentially Affect Insulin Sensitivity, Body Composition, Cardiorespiratory Fitness, and Muscle Strength in Older Adults With Obesity: A Randomized Controlled Trial","volume":"77","author":"Brennan","year":"2022","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.2147\/CIA.S194543","article-title":"Grip Strength: An Indispensable Biomarker for Older Adults","volume":"14","author":"Bohannon","year":"2019","journal-title":"Clin. Interv. Aging"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"524S","DOI":"10.1093\/ajcn\/64.3.524S","article-title":"Bioelectrical impedance analysis in body composition measurement: National Institutes of Health Technology Assessment Conference Statement","volume":"64","author":"Yanovski","year":"1996","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1097\/MED.0000000000000934","article-title":"Effect of GLP-1 receptor agonists on body composition","volume":"32","author":"Bhandarkar","year":"2025","journal-title":"Curr. Opin. Endocrinol. Diabetes Obes."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1080\/14656566.2024.2343092","article-title":"A systematic review of the effect of semaglutide on lean mass: Insights from clinical trials","volume":"25","author":"Bikou","year":"2024","journal-title":"Expert Opin. Pharmacother."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"377","DOI":"10.14740\/jocmr4987","article-title":"Oral Semaglutide Induces Loss of Body Fat Mass Without Affecting Muscle Mass in Patients with Type 2 Diabetes","volume":"15","author":"Uchiyama","year":"2023","journal-title":"J. Clin. Med. Res."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Wen, Y., Liu, T., Ma, C., Fang, J., Zhao, Z., Luo, M., Xia, Y., Zhao, Y., and Ji, C. (2022). Association between handgrip strength and metabolic syndrome: A meta-analysis and systematic review. Front. Nutr., 9.","DOI":"10.3389\/fnut.2022.996645"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1111\/dom.15728","article-title":"Changes in lean body mass with glucagon-like peptide-1-based therapies and mitigation strategies","volume":"26","author":"Neeland","year":"2024","journal-title":"Diabetes Obes. Metab."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1161\/CIRCULATIONAHA.124.067676","article-title":"Muscle Mass and Glucagon-Like Peptide-1 Receptor Agonists: Adaptive or Maladaptive Response to Weight Loss?","volume":"150","author":"Linge","year":"2024","journal-title":"Circulation"},{"key":"ref_57","first-page":"351","article-title":"Nutrition support whilst on glucagon-like peptide-1 based therapy. Is it necessary?","volume":"28","author":"Chavez","year":"2025","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.clnesp.2024.06.030","article-title":"Enhanced protein intake on maintaining muscle mass, strength, and physical function in adults with overweight\/obesity: A systematic review and meta-analysis","volume":"63","author":"Kokura","year":"2024","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1016\/j.eprac.2025.12.010","article-title":"A Meta-Analysis of Body Composition Changes Associated with Long-term Use of Sodium-Glucose Cotransporter 2 Inhibitors","volume":"32","author":"Yamamoto","year":"2026","journal-title":"Endocr. Pract."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Volpe, S., Vozza, A., Lisco, G., Fanelli, M., Racaniello, D., Bergamasco, A., Triggiani, D., Pierangeli, G., De Pergola, G., and Tortorella, C. (2024). Sodium-Glucose Cotransporter 2 Inhibitors Improve Body Composition by Increasing the Skeletal Muscle Mass\/Fat Mass Ratio in Patients with Type 2 Diabetes: A 52-Week Prospective Real-Life Study. Nutrients, 16.","DOI":"10.3390\/nu16223841"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1111\/j.1751-7176.2009.00063.x","article-title":"Insulin therapy and type 2 diabetes: Management of weight gain","volume":"11","author":"McFarlane","year":"2009","journal-title":"J. Clin. Hypertens."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1007\/s12325-018-0824-8","article-title":"Body Weight Considerations in the Management of Type 2 Diabetes","volume":"36","author":"Apovian","year":"2019","journal-title":"Adv. Ther."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Sun, L., Fu, J., Mu, Z., Duan, X., Chan, P., and Xiu, S. (2023). Association between body fat and sarcopenia in older adults with type 2 diabetes mellitus: A cross-sectional study. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1094075"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.2147\/DMSO.S360942","article-title":"Sarcopenic Obesity with Normal Body Size May Have Higher Insulin Resistance in Elderly Patients with Type 2 Diabetes Mellitus","volume":"15","author":"Han","year":"2022","journal-title":"Diabetes Metab. Syndr. Obes."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1038\/s41591-022-01790-7","article-title":"Heterogeneity in phenotype, disease progression and drug response in type 2 diabetes","volume":"28","author":"Nair","year":"2022","journal-title":"Nat. Med."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1007\/s40200-025-01614-8","article-title":"Grip strength, metabolic syndrome, and type 2 diabetes mellitus: A prospective study","volume":"24","author":"Rho","year":"2025","journal-title":"J. Diabetes Metab. Disord."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"156057","DOI":"10.1016\/j.metabol.2024.156057","article-title":"The impact of weight loss on fat-free mass, muscle, bone and hematopoiesis health: Implications for emerging pharmacotherapies aiming at fat reduction and lean mass preservation","volume":"161","author":"Stefanakis","year":"2024","journal-title":"Metabolism"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.1161\/CIR.0000000000001221","article-title":"Implementation of Obesity Science into Clinical Practice: A Scientific Statement from the American Heart Association","volume":"150","author":"Laddu","year":"2024","journal-title":"Circulation"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s41043-024-00500-y","article-title":"Hand grip strength as a proposed new vital sign of health: A narrative review of evidences","volume":"43","author":"Vaishya","year":"2024","journal-title":"J. Health Popul. Nutr."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"e13428","DOI":"10.1111\/obr.13428","article-title":"Resistance training effectiveness on body composition and body weight outcomes in individuals with overweight and obesity across the lifespan: A systematic review and meta-analysis","volume":"23","author":"Lopez","year":"2022","journal-title":"Obes. 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