Diabetes mellitus and preventable spinal cord injury

A high prevalence of diabetes mellitus (DM) among spinal cord injury (SCI) populations has been noted. A review and follow-up of acute admissions to a SCI service was conducted to explain this high prevalence.

Records of 166 patients admitted for rehabilitation within 108 days of paralysis were reviewed. Cases of DM were identified by records of treatment or fasting blood glucose levels > 140 mg% or hemoglobin A1c < 7 g%. The onset of DM relative to SCI, the age at injury, and the cause of injury were recorded. New cases of DM and all deaths within a 5-year follow-up were determined for those patients 40 years of age or older at paralysis.

The prevalence of DM was 0 of 79 younger patients (aged 16 to 39 years) but 18 of 87 older patients (aged 40 to 86 years), or 21%. All patients with DM had been diagnosed before SCI (16 patients) or during the initial hospitalization (2 patients). The cause of injury was falling in 11 of 18 (61%) DM patients and 31 of 69 (45%) nondiabetic older patients (P = 0.29). Falling was a less common cause of injury in the younger group (13 of 78 [17%], P < 0.001). The cause of paralysis was medical (ie, vascular, infectious) in 5 patients in the DM group (28%) and 5 patients in the non-DM group (6%) (P = 0.03). The 5-year mortality for patients with DM was 7 of 17 (one lost to follow-up) (41%) and 10 of 64 (16%; 5 lost to follow-up) for the nondiabetic older patients (P = 0.04). The 5-year prevalence of DM in the survivors (4 patients developed DM, 1 patient did not survive) was 23%, similar to the initial prevalence.

DM is a risk factor for SCI. Attention to this risk could prevent some SCIs.