Objective To explore the clinical application value of high frequency ultrasound combined with acoustic radiation force impulse in patients with diabetic sarcopenia(DSA).Methods A total of 196 patients with type 2 diabetes mellitus(T2DM)who were hospitalized in the Endocrinology Department of the First Affiliated Hospital of Longyan City,Fujian Medical University were enrolled in this study from January 2022 to February 2023.All the participants were divided into two groups:simple T2DM group(n=120)and combined DSA group(DSA,n=76)according to the limb skeletal muscle mass index(ASMI).During the same period,40 healthy individuals who underwent physical examination were selected as the normal control(NC)group.The general information and biochemical indicators were analyzed in each group.And the muscle thickness,pinnate angle,muscle bundle length and shear wave velocity of the medial head of the right gastrocnemius muscle were compared among the groups.Results The thickness,feathery angle,muscle bundle length,and shear wave velocity of the medial head muscle of the right gastrocnemius muscle were lower in DSA group than in NC and T2DM groups(P＜0.05).Pearson correlation analysis showed that ASMI was positively correlated with body weight,BMI,TC,albumin,total protein,muscle thickness,feather angle,muscle bundle length,and shear wave velocity(P＜0.05),while negatively correlated with age,FPG and HbA1c(P＜0.05).Binary logistic regression analysis showed that muscle thickness and shear wave velocity are influencing factors for DSA.The analysis of the receiver operating characteristic(ROC)curve of the subjects showed that the area under the ROC curve of muscle thickness and shear wave velocity was 0.826 and 0.877(P＜0.05).The diagnostic thresholds for DSA were 14.1 mm and 1.63 m/s,with sensitivity of 0.953 and 0.903,and specificity of 0.971 and 0.941.Conclusions Ultrasound measurement of the muscle thickness and shear wave velocity of the medial head of the right gastrocnemius muscle can be used to diagnose diabetic sarcopenia.