BACKGROUND: Epidemiological studies demonstrate an association between diabetes and low neuromuscular strength (NMS). However, none have grouped participants into non-diabetics (ND), undiagnosed diabetics (UDD), controlled diabetics (CD) and uncontrolled diabetics (UCD) or investigated what glycated hemoglobin levels (HbA1c) are associated with low NMS (dynapenia) by sex. METHODS: We analyzed the association between UDD, CD and UCD and dynapenia, the extent to which the different groupings of these individuals modifies this association and the association between HbA1c levels and NMS, by sex, in a cross-sectional study involving 5,290 participants ≥ 50 years from the ELSA study. In the first two analyses, logistic regression models were used with dynapenia (grip strength < 26kg in men and < 16kg in women) as outcome and diabetes [ND, UDD, CD and UCD] as exposure. Next, linear regression was performed with grip strength as outcome and the participants classified based on HbA1c level as exposure. The models were adjusted by sociodemographic, behavioral and clinical characteristics. RESULTS: Compared to ND only UCD was associated with dynapenia (men OR=2.37 95% CI 1.36-4.14; women OR=1.67 95% CI 1.01-2.79). This association was less clear, particularly in women, when CD and UCD groups were merged. HbA1c ≥ 6.5% in men and ≥ 8.0% in women were associated with lower NMS. CONCLUSIONS: UCD increases the chance of dynapenia in both sexes. The different groupings based on diabetes status modify the association between UCD and dynapenia. The threshold of HbA1c associated with reduced NMS is lower in men compared to women
