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

Spinal Cord volume 62, pages 164–169 (2024)Cite this article

Subjects

Abstract

Study design

Retrospective longitudinal cohort study of veterans with SCI.

Objectives

Spinal cord injury (SCI) is associated with an increased risk of developing diabetes mellitus (DM), likely due to body composition alterations and autonomic nervous system dysfunction. These factors are more pronounced in persons with tetraplegia (TP) versus paraplegia (PP). However, the effect of level of injury (LOI) on DM incidence is largely unknown. Therefore, the objective is to examine the effect of LOI on DM incidence in persons with SCI.

Setting

South Texas Veterans Health Care System.

Methods

We obtained electronic record data on age, sex, race/ethnicity, LOI and HbA1c concentration from January 1st 2001 through December 31st 2021. Cox proportional hazard regression analyses were used to assess the association between LOI, DM and all-cause mortality.

Results

Among 728 non-diabetic veterans with SCI (350 TP/ 378 PP, 52 ± 15 years, 690 male/38 female) 243 developed DM, of which 116 with TP and 127 with PP. Despite chronological variations between TP and PP, DM risk over the entire follow-up did not differ between the groups (hazard ratio (HR): 1.06, 95% CI: 0.82–1.38). Mortality was higher in TP versus PP (HR: 1.40, 95% CI: 1.09–1.78). However, developing DM did not increase the risk of death, regardless of LOI (HR: 1.07, 95% CI: 0.83–1.37).

Conclusion

Despite chronological variations between both groups, the level of injury had minimal effect on long-term DM development in this cohort of veterans with SCI. Sponsorship NIH (DK105379; MS), RR&D SPiRE (I21RX003724-01A1; MT and SH).

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Fig. 1: Consort chart of the subjects enrolled and included in the analyzed data set.
Fig. 2: Rates of diabetes mellitus in subjects with tetraplegia and paraplegia during the 21-year follow-up.
Fig. 3: Rates of mortality in subjects with and without diabetes mellitus developed during the 21-year follow-up.

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Data availability

Data are available upon reasonable request.

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Acknowledgements

This material is the result of work supported with resources and the use of facilities at the Audie L. Murphy Veteran’s Affairs Hospital in San Antonio, TX.

Funding

This work was supported by a grant from the National Institute of Health, DK105379 (MS) and a RR&D Small Projects in Rehabilitation Research (SPiRE) grant, I21RX003724-01A1 (MT and SH).

Author information

Author notes

  1. These authors contributed equally: Sven Hoekstra, Michelle Trbovich.

Authors and Affiliations

  1. Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Sven Hoekstra & Michelle Trbovich

  2. Audie Murphy Hospital, South Texas Veteran’s Health Care System, San Antonio, TX, USA

    Sven Hoekstra, Michelle Trbovich, Michael Mader & Marzieh Salehi

  3. School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK

    Sven Hoekstra

  4. Department of Cell Systems and Anatomy, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Wouter Koek

  5. Department of Medicine, Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Marzieh Salehi

Authors
  1. Sven Hoekstra
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  2. Michelle Trbovich
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  4. Michael Mader
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Contributions

SH was responsible for data interpretation and writing of the manuscript; MT was responsible for conceptualizing the study, data extraction, data interpretation and editing of the manuscript; WK was responsible for data analysis and assisted in data interpretation; MM was responsible for data extraction, data analysis and assisted in data interpretation. MS was responsible for conceptualizing the study, data extraction, data interpretation and editing of the manuscript.

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Correspondence to Sven Hoekstra.

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Hoekstra, S., Trbovich, M., Koek, W. et al. The effect of level of injury on diabetes incidence and mortality after spinal cord injury – a longitudinal cohort study. Spinal Cord 62, 164–169 (2024). https://doi.org/10.1038/s41393-024-00961-2

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