title: Spinal cord injury increases the risk of type 2 diabetes: a population-based cohort study.
abstract: BACKGROUND
  Previous studies on the risk and prevalence of diabetes among spinal cord injury (SCI) patients are limited and controversial.
  
  
  OBJECTIVE
  To compare the risk and incidence rate (IR) of Type 2 diabetes in SCI and non-SCI patients.
  
  
  METHODS
  This is a population-based retrospective cohort study.
  
  
  METHODS
  Data from Taiwan's National Health Insurance Research Database for the period 1997 to 2010 were analyzed. Patients aged 20 years and older newly identified with SCIs during this period were included in the SCI cohort. A non-SCI comparison cohort was randomly selected from National Health Insurance beneficiaries and matched with the SCI cohort based on age, sex, and index date.
  
  
  METHODS
  Both cohorts were followed until the first of the following occurred: the diagnosis of Type 2 diabetes (International Classification of Disease, Ninth Revision, Clinical Modification codes 250), withdrawal from the insurance system, the end of 2010, or death.
  
  
  METHODS
  A Cox proportional hazards regression analysis was used to estimate the risk of developing diabetes.
  
  
  RESULTS
  Taiwan possesses an older SCI population, with a mean age of 51.6 years. The IR for diabetes in patients with and without SCIs was 22.1 per 10,000 person-years and 17.2 per 10,000 person-years, respectively. The adjusted hazard ratio (HR) for diabetes was 1.33 times higher in patients with SCIs than in those without SCIs. In patients with SCIs, men (adjusted HR=1.23, 95% confidence interval (CI)=1.04-1.44), older people (adjusted HR=4.26 in patients older than 65 years, 95% CI=3.16-5.74), patients with comorbidity (adjusted HR=1.36, 95% CI=1.14-1.62), and patients with a complete thoracic SCI (T-spine injury) (adjusted HR=2.13, 95% CI=0.95-4.79) were more likely to be diagnosed with diabetes than other patient subgroups.
  
  
  CONCLUSIONS
  Our findings may facilitate the prioritizing of preventive health strategies and planning of long-term care for SCI patients.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, No.1, Rongguang Rd, Puli Township, Nantou County 545, Taiwan.
authors.forename: Yun-Ju
authors.initials: YJ
authors.lastname: Lai
authors.affiliation: Management Office for Health Data, China Medical University Hospital, No. 2, Yuh-Der Rd, Taichung 404, Taiwan.
authors.forename: Cheng-Li
authors.initials: CL
authors.lastname: Lin
authors.affiliation: Management Office for Health Data, China Medical University Hospital, No. 2, Yuh-Der Rd, Taichung 404, Taiwan.
authors.forename: Yen-Jung
authors.initials: YJ
authors.lastname: Chang
authors.affiliation: Department of Nuclear Medicine, E-DA Hospital, No.1, Yida Rd, Jiaosu Village, Yanchao District, Kaohsiung City 82445, Taiwan.
authors.forename: Ming-Chia
authors.initials: MC
authors.lastname: Lin
authors.affiliation: Department of Family Medicine, Puli Branch of Taichung Veterans General Hospital, No.1, Rongguang Rd, Puli Township, Nantou County 545, Taiwan.
authors.forename: Shih-Tan
authors.initials: ST
authors.lastname: Lee
authors.affiliation: Management Office for Health Data, China Medical University Hospital, No. 2, Yuh-Der Rd, Taichung 404, Taiwan; Department of Public Health, China Medical University, No. 2, Yuh-Der Rd, Taichung 404, Taiwan.
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
authors.affiliation: Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Rd, Taichung 404, Taiwan; China Medical University Hospital Taipei Branch, No. 360, Sec. 2, Neihu Rd. Neihu District, Taipei, Taiwan.
authors.forename: Wen-Yuan
authors.initials: WY
authors.lastname: Lee
authors.affiliation: Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Rd, Taichung 404, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, No. 2, Yuh-Der Rd, Taichung 404, Taiwan. Electronic address: d10040@mail.cmuh.org.tw.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications*; D013624:Taiwan / Q000453:epidemiology
keywords: Cohort study; NHI; NHIRD; NHRI; Spinal cord injury; Type 2 diabetes