Diabetes mellitus and preventable spinal cord injury

Purpose: 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. Methods: 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 A] c < 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. Results: 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 I I 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 (113 of 78 [117%], 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 DIVI in the survivors (4 patients developed DM, 1 patient did not survive) was 23%, similar to the initial prevalence. Conclusion: DM is a risk factor for SCI. Attention to this risk could prevent some SCIs.