Spinal cord injury increases the risk of Type 2 diabetes: A population-based cohort study

Yun Ju Lai, Cheng Li Lin, Yen Jung Chang, Ming Chia Lin, Shih Tan Lee, Fung Chang Sung, Wen Yuan Lee, Chia Hung Kao*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)


Background context Previous studies on the risk and prevalence of diabetes among spinal cord injury (SCI) patients are limited and controversial. Purpose To compare the risk and incidence rate (IR) of Type 2 diabetes in SCI and non-SCI patients. Study design This is a population-based retrospective cohort study. Patient sample 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. Outcome measures 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.

Original languageEnglish
Pages (from-to)1957-1964
Number of pages8
JournalSpine Journal
Issue number9
Publication statusPublished - 2014 Sep 1
Externally publishedYes


  • Cohort study
  • NHI
  • NHRI
  • Spinal cord injury
  • Type 2 diabetes

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology


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