{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:16:50Z","timestamp":1792513010230,"version":"4.5.0"},"reference-count":93,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The management of type 2 diabetes (T2D) extends beyond glycemic control, requiring a more global strategy that includes optimization of body composition, even more so in the context of sarcopenia and visceral adiposity, as they contribute to poor outcomes. Past reviews have typically been focused on weight reduction or glycemic effectiveness, with limited inclusion of new therapies\u2019 effects on muscle and fat distribution. In addition, the emergence of incretin-based therapies and dual agonists such as tirzepatide requires an updated synthesis of their impacts on body composition. This review attempts to bridge the gap by taking a systematic approach to how current blood-glucose lowering therapies affect lean body mass, fat mass, and the risk of sarcopenia in T2D patients. Materials and Methods: Between January 2015 and March 2025, we conducted a narrative review by searching the PubMed, Scopus, and Web of Science databases for English-language articles. The keywords were combinations of the following: \u201ctype 2 diabetes,\u201d \u201clean body mass,\u201d \u201cfat mass,\u201d \u201cbody composition,\u201d \u201csarcopenia,\u201d \u201cGLP-1 receptor agonists,\u201d \u201cSGLT2 inhibitors,\u201d \u201ctirzepatide,\u201d and \u201cantidiabetic pharmacotherapy.\u201d Reference lists were searched manually as well. The highest precedence was assigned to studies that aimed at adult type 2 diabetic subjects and reported body composition results. Inclusion criteria for studies were: (1) type 2 diabetic mellitus adult patients and (2) reporting measures of body composition (e.g., lean body mass, fat mass, or muscle function). We prioritized randomized controlled trials and large observational studies and excluded mixed diabetic populations, non-pharmacological interventions only, and poor reporting of body composition. Results: Metformin was widely found to be weight-neutral with minimal effects on muscle mass. Insulin therapy, being an anabolic hormone, often leads to fat mass accumulation and increases the risk of sarcopenic obesity. Incretin-based therapies induced substantial weight loss, mostly from fat mass. Notable results were observed in studies with tirzepatide, demonstrating superior reduction not only in fat mass, but also in visceral fat. Sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors) promote fat loss but are associated with a small yet significant decrease in lean muscle mass. Conclusions: Blood-glucose lowering therapies demonstrated clinically relevant effects on body composition. Treatment should be personalized, balancing glycemic control, cardiovascular, and renal benefits, together with optimal impact on muscle mass along with glycemic, cardiovascular, and renal benefits.<\/jats:p>","DOI":"10.3390\/medicina61081399","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T09:41:17Z","timestamp":1754300477000},"page":"1399","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Effects of Blood-Glucose Lowering Therapies on Body Composition and Muscle Outcomes in Type 2 Diabetes: A Narrative Review"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6594-2031","authenticated-orcid":false,"given":"Ioana","family":"Bujdei-Tebeic\u0103","sequence":"first","affiliation":[{"name":"Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 030167 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4925-2221","authenticated-orcid":false,"given":"Doina Andrada","family":"Mihai","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 030167 Bucharest, Romania"},{"name":"National Institute of Diabetes, Nutrition and Metabolic Diseases \u201cProf. N. Paulescu\u201d, 030167 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0555-526X","authenticated-orcid":false,"given":"Anca Mihaela","family":"Pantea-Stoian","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 030167 Bucharest, Romania"},{"name":"National Institute of Diabetes, Nutrition and Metabolic Diseases \u201cProf. N. Paulescu\u201d, 030167 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8518-650X","authenticated-orcid":false,"given":"Simona Diana","family":"\u0218tefan","sequence":"additional","affiliation":[{"name":"National Institute of Diabetes, Nutrition and Metabolic Diseases \u201cProf. N. Paulescu\u201d, 030167 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2686-8778","authenticated-orcid":false,"given":"Claudiu","family":"Stoicescu","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Cardiovascular Surgery, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 030167 Bucharest, Romania"},{"name":"Department of Cardiology, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Serafinceanu","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 030167 Bucharest, Romania"},{"name":"National Institute of Diabetes, Nutrition and Metabolic Diseases \u201cProf. N. Paulescu\u201d, 030167 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,1]]},"reference":[{"key":"ref_1","unstructured":"Magliano, D.J., and Boyko, E.J. (2025). IDF Diabetes Atlas, International Diabetes Federation."},{"key":"ref_2","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. 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