Phenotypic Characterization of Sarcopenia in Patients With Diabetic Neuropathy: The Role of Pain and Motor Dysfunction
DOI:
https://doi.org/10.66201/ss.v1.3Keywords:
Diabetic Neuropathy, Sarcopenia, Dynapenia, Neuropathic Pain, Phenotype, MyosteatosisAbstract
Introduction: Although diabetic peripheral neuropathy (DPN) is a known risk factor for sarcopenia, the literature has not sufficiently characterized the differential impact of clinical phenotypes, specifically painful versus painless DPN, on muscle function. The aim of this review is to assess and compare the prevalence, underlying pathophysiological mechanisms, and clinical characteristics of sarcopenia and dynapenia (weakness) in patients with painful versus painless DPN.
Methods: A comprehensive integrative review of the scientific literature was conducted (January 2014 to January 2024) using PubMed, Scopus, and Scite.ai. The Whittemore and Knafl framework was applied, and the MMAT and JBI tools were used to assess the methodological quality of observational studies and clinical trials that stratified patients by neuropathic symptomatology.
Results: The pain phenotype is significantly associated with earlier onset of dynapenia and greater clinical severity. This functional impairment is driven by a “biobehavioral vicious cycle” that includes kinesiophobia (avoidance of movement) and a state of systemic neuroinflammation (characterized by elevated levels of TNF-α and IL-6). Furthermore, conventional screening tools, such as the SARC-F questionnaire, have been found to have low sensitivity in this population. Muscle ultrasound, by detecting early qualitative changes such as myosteatosis (fatty infiltration), emerges as a superior screening technique.
Conclusions: Neuropathic pain is an independent catalyst for accelerated motor disability. A high-risk profile is proposed that requires priority screening strategies using dynamometry and advanced imaging techniques. Pain management should be redefined as an essential intervention for preserving muscle function.
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Copyright (c) 2026 Junia Correa Nogueira, Lara Vitoria De Paula Oliveira, Jane De Souza Teixeira, Rosana Rosário Dos Santos Mendes, Tainah Natividade P. De Santana, Miguel Mottola De Oliveira Becegato, Maria Eduarda Dinnebier, Paola Thalia Danielli
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