Patients With Neurogenic Lower Urinary Tract Dysfunction Following Spinal Cord Injury Are at Increased Risk of Developing Type 2 Diabetes Mellitus: A Population-Based Cohort Study

Medicine, 2016 · DOI: 10.1097/MD.0000000000002518 · Published: January 1, 2016

Spinal Cord Injury Urology Endocrinology

Simple Explanation

This study investigates the link between neurogenic lower urinary tract dysfunction (NLUTD) after spinal cord injury (SCI) and the risk of developing type 2 diabetes mellitus (T2DM). Using data from a large Taiwanese health database, researchers compared SCI patients with and without NLUTD to see if NLUTD increases the likelihood of developing T2DM. The study found that SCI patients with NLUTD had a higher risk of developing T2DM compared to those without NLUTD. This suggests that NLUTD following SCI may significantly increase the risk of developing T2DM, particularly in patients aged 60 years and older. The researchers suggest that chronic inflammation of the bladder, common in NLUTD, may contribute to insulin resistance and the development of type 2 diabetes in SCI patients. Therefore, managing bladder inflammation could be a key strategy to reduce diabetes risk in this population.

Study Duration

9 Years

Participants

3515 patients with newly diagnosed SCI

Evidence Level

Not specified

Key Findings

1
The incidence rate ratio of T2DM was higher in the NLUTD group compared to the control group (4.94 vs. 2.61 per 10,000 person-years).
2
Patients with NLUTD had a significantly increased adjusted hazard ratio (AHR) of 1.70 (95% CI 1.11–2.61) for type 2 diabetes.
3
The increased AHR of type 2 diabetes was only observed in patients with NLUTD aged ≥60 years (2.52; 95% CI 1.35–4.70).

Research Summary

This retrospective cohort study investigated the association between neurogenic lower urinary tract dysfunction (NLUTD) following spinal cord injury (SCI) and the risk of developing type 2 diabetes mellitus (T2DM). The study found that patients with NLUTD following SCI had a significantly increased risk of developing T2DM, particularly those aged 60 years and older. The authors suggest that chronic inflammation of the bladder, a common feature of NLUTD, may contribute to insulin resistance and the development of T2DM in SCI patients.

Practical Implications

Bladder Management Strategies

Reducing chronic inflammation of the bladder should be included in bladder management to decrease new-onset type 2 diabetes in SCI patients.

Botulinum Toxin A (BTX-A) Treatment

BTX-A may inhibit the release of sensory neurotransmitters in bladder preparations isolated from rats with acute injury and chronic inflammation, suggesting a potential clinical benefit.

Interventional Programs

Interventional programs to reduce the risk of type 2 diabetes onset should be considered and administered to SCI patients who develop NLUTD.

Study Limitations

1
Lack of detailed information on risk factors for type 2 diabetes such as physical inactivity, hemoglobin A1C level, body mass index, and family history.
2
The NHIRD does not accurately distinguish between complete and incomplete spinal cord injuries.
3
The authors used ICD-9-CM codes to determine type 2 diabetes, which might entail certain degrees of misclassification.

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