Short-Term and Long-Term Risk of Diabetes Mellitus among Patients with Spinal Cord Injury: A Nationwide Retrospective Cohort Study.

ABSTRACT

OBJECTIVES: Estimating the risk of diabetes mellitus (DM) is important for the proper management of patients with spinal cord injury (SCI). We investigated the short-term and long-term risks of DM among patients with SCI, according to the presence or severity of post-SCI disability and the level of injury. METHODS: We conducted a retrospective cohort study using the Korean National Health Insurance Service (2010-2018) database. After matching by age and sex, 6129 SCI patients and 22,979 controls were included. The primary outcome was incident DM, and risk was evaluated for both the short term (within 1 year after SCI) and the long term (after 1 year of SCI diagnosis). RESULTS: The risk of DM was higher among patients with cervical- and thoracic-level SCI accompanied by disability compared to the controls during follow-up (4.6 ± 2.6 years). The short-term risk of DM was higher among patients with SCI (odds ratio [OR] 2.51, 95% confidence interval [CI] 1.91-3.27) than among the controls and it was even higher among patients with severe disability (OR 5.38, 95% CI 2.91-9.27). According to the level of injury, patients with cervical SCI had the highest short-term risk of DM (with disability, OR 4.93, 95% CI 3.07-7.63). There was no significant increase of DM risk in the long term, after 1 year of SCI diagnosis. CONCLUSIONS: Patients with SCI accompanied by severe disability and cervical-level injury had higher risks of pronounced DM in the short term. The findings of this study emphasize the need for active surveillance of DM among patients with high-level SCI and disability, especially in the short term, in addition to continuous monitoring and proper management of DM in the long term.