Abstract
BACKGROUND: Sarcopenia affects approximately 10-27% of adults with type 2 diabetes mellitus (T2DM), roughly double the prevalence in age-matched non-diabetic populations. Dual-energy X-ray absorptiometry (DXA) is the consensus reference method for quantifying muscle mass, but its cost, radiation exposure, and infrastructure requirements limit its routine clinical use. Bioelectrical impedance analysis (BIA) is portable, inexpensive, and radiation-free. However, T2DM-associated alterations in tissue hydration, extracellular water distribution, and electrical conductivity may compromise BIA accuracy. No disease-specific systematic review has evaluated whether BIA constitutes a viable alternative to DXA for sarcopenia assessment in T2DM. OBJECTIVES: To evaluate whether BIA is a viable alternative to DXA for (1) muscle mass and body composition estimation, (2) sarcopenia classification and prevalence estimation, and (3) sarcopenia screening in adults with T2DM, using a three-tier synthesis framework. METHODS: Five electronic databases (PubMed, Embase, Scopus, Web of Science, CINAHL) will be searched from inception without language restrictions, supplemented by citation searching. Studies comparing BIA with DXA in adults with confirmed T2DM reporting any agreement statistic or sarcopenia prevalence are eligible. Two reviewers will independently screen records, extract data, and assess risk of bias using QUADAS-C. Tier 1 analyses will pool ICC and Bland-Altman bias using random-effects models and Fisher z-transformation. Tier 2 will pool DXA-based sarcopenia prevalence (logit scale) and BIA-DXA risk difference. Tier 3 will narratively synthesise sensitivity, specificity, and AUC. GRADE will be applied to assess the certainty of evidence. DISSEMINATION: Findings will be published in a Scopus-indexed journal and presented at a reputable conference.
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