Diabetes, Muscles, and the Myth of Ulysses' Bow

At the end of Homer's Odyssey, after 20 years of adventurous traveling, the goddess Athena brings Ulysses back to Ithaca disguised as an old man. With little hope for Ulysses' return, his faithful wife Penelope has reluctantly agreed to marry whoever wins a contest using Ulysses' bow. In spite of his infirmed appearance, Ulysses is the only contestant strong enough to string the bow and shoot an arrow through 12 axe-handles. Thus, the image of a hero as the “only one who can string the bow” has been embedded in civilization since before the beginning of written history and suggests that from time immemorial, people have equated strong muscles with youth and good health. Thousands of years later, we are beginning to understand exactly how health and age affect muscle, and we are now on the cusp of translating that knowledge into medical research and practice.

In this issue of Diabetes Care, Park et al. (1) from the Health, Aging, and Body Composition Study group report that in individuals aged 70–79 years, a diagnosis of diabetes is associated with accelerated decline in muscle mass, especially in women and in subjects with undiagnosed diabetes. These longitudinal findings open an important chapter in our understanding of the complications and consequences of diabetes and its effect on physical function. However, to fully understand the relevance of these findings, we should interpret them in the context of the known effects of age on body composition and of diabetes on muscle strength and physical function (2,3).

The aging process is associated with consistent changes in body composition in all animal species, from worms to rodents to primates, with few exceptions (4–6). With increasing age, lean …