The effect of level of injury on diabetes incidence and mortality after spinal cord injury – a longitudinal cohort study

Spinal Cord, 2024 · DOI: 10.1038/s41393-024-00961-2 · Published: April 1, 2024

Simple Explanation

This study investigated the relationship between the level of spinal cord injury (SCI) and the development of diabetes (DM) in veterans. It compared the incidence of DM in individuals with tetraplegia (TP) versus paraplegia (PP). The study found that while there were chronological differences in DM development between the two groups, the overall risk of developing DM over the 21-year follow-up period was similar for both TP and PP. The research also examined the impact of DM on mortality in SCI patients and found that developing DM did not increase the risk of death, regardless of the level of injury.

Study Duration

21 years

Participants

728 non-diabetic veterans with SCI (350 TP/ 378 PP, 52 ± 15 years, 690 male/38 female)

Evidence Level

Longitudinal cohort study

Key Findings

1
The risk of DM development over the 21-year follow-up period did not differ significantly between those with tetraplegia (TP) and paraplegia (PP).
2
Mortality was higher in subjects with TP compared to PP, but developing DM did not increase the risk of death regardless of the level of injury.
3
Older age, higher HbA1c levels, and higher BMI at baseline increased the risk for DM development.

Research Summary

This retrospective longitudinal cohort study examined the effect of the level of spinal cord injury (SCI) on the incidence of diabetes mellitus (DM) and mortality in a cohort of veterans. The study found no significant difference in the overall risk of DM development between individuals with tetraplegia and paraplegia over a 21-year follow-up period, although chronological variations were observed. While mortality was higher in those with tetraplegia, developing DM did not increase the risk of death in this SCI cohort. Baseline HbA1c was identified as a key predictor of DM development.

Practical Implications

Personalized Prevention

Further studies are needed to investigate pathophysiological differences among persons with TP and PP, which in turn can help with the development of personalized preventive and treatment strategies that are specific to the lesion level.

Resource Allocation

The similar DM incidence in TP and PP found in the current study suggests that resources for such endeavors should be divided equally among these SCI sub-populations.

Continued Monitoring

The present longitudinal study provides support for the continued use of HbA1c to identify people at risk for DM, while the HbA1c threshold for DM-risk or cardiometabolic complications in this population remains to be investigated.

Study Limitations

1
DM diagnosis was based on one rather than two blood sample collections, potentially overestimating DM incidence.
2
Data on lesion completeness was not available, which may influence DM incidence differences.
3
The cohort consisted predominantly of males, limiting generalizability to female populations.

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