Objective: Low alanine aminotransferase (ALT) level is associated with frailty in the elderly population. However, the association of this biomarker with diabetics is unclear. We investigated the usefulness of ALT in predicting low muscle strength among elderly patients with diabetes, irrespective of accompanying metabolic disorders. Methods: We included 592 men aged ≥ 50 years and 564 postmenopausal women. All participants had diabetes, and data were based on the 2014-2016 Korea National Health and Nutrition Examination Survey. Participants with ALT levels confounded by hepatic causes were excluded. The accompanying metabolic disorders and the associated parameters were evaluated. Low muscle strength was defined as hand grip strength (HGS) below the Korean-specific cut-off value. Results: The relationship between ALT and low muscle strength was inversely correlated with both obesity and hypertriglyceridemia. In men and women, when ALT level was divided into quartiles [1Q-4Q], a positive correlation between ALT and body mass index (BMI) and triglycerides (TG) and glycated hemoglobin (HbA1c) levels was observed, while a negative correlated was observed with age, duration of diabetes, and prevalence of low muscle strength. After adjusting for age, sex, protein intake, aerobic exercise, BMI, duration of diabetes, HbA1c, TG, and cerebrovascular events, the lower ALT quartile [1Q and 2Q] showed a significantly higher risk for low muscle strength compared to 4Q (OR = 2.470 and 2.919, respectively, p-for- trend Conclusion: Elderly patients with diabetes with ALT levels below low-tonormal should not be considered metabolically healthy. Clinicians should pay special attention to the risk of low muscle strength in individuals with ALT levels of ≤ 18.5 mg/dL, independent of any associated metabolic disorders.