194-OR: The Effect of Level of Spinal Cord Injury on the Prevalence of Diabetes

Abstract

Persons with spinal cord injury (SCI) develop diabetes at much higher rates than those with able bodies. Glycemic effect of SCI is exaggerated in those with higher level of injury (LOI) (e.g.: tetraplegia [TP]) compared to those with lower LOI (e.g.; paraplegia [PP]) . We hypothesized that prevalence and incidence of diabetes is higher in those with higher LOI among SCI patients. In a retrospective cohort study of veterans with spinal cord injury, from 20to 2021, electronic record data on weight, height, gender, ethnicity, level of injury (TP vs. PP) , glucose and A1C levels, and antidiabetic medications were obtained. Diabetes was defined by random glucose >200 mg/dl and HbA1C>6.5%. A total of 9persons with SCI were identified (440 TP/ 471 PP,48 F/863 M, age (22-90) , BMI (13.1-51.4)) . The prevalence of diabetes at the first visit among those with TP and PP was similar (21vs. 20%) . Among 728 nondiabetic subjects with SCI, 1 (34%) with TP vs. 127 (34%) with PP developed type 2 diabetes over a median period of 40m (18-93) vs. 39m (15-75) (p=0.3) . Groups were similar for age and gender distribution, but PP had greater BMI compared to TP (p<0.01) . Despite similar A1C and plasma glycemia between the 2 groups at their first encounters, PP subjects had higher glycemic control estimated by A1C at the time of DM conversion or their last encounter (6.4± 1.7% vs. 6.0± 1.1%, p<0.05) . Of note, a larger number of diabetic patients in this cohort did not receive any antidiabetes medications (76% in TP/ 65% in PP, p=0.09) . At the end of 20-year study period, there were a total of 72 deaths in TP patients with diabetes compared to 60 deaths in PP patients with diabetes (61% vs. 47%, p<0.05) . Our findings indicate that despite greater amount of innervated lean muscle mass and lesser impaired autonomic nervous signaling in persons with PP compared to TP, rate of diabetes development and glycemic control are relatively similar among those with the high and low LOI. However, among SCI patients with diabetes those with TP had worse survival rate than PP. Disclosure M.Trbovich: None. R.Dimas: None. M.J.Mader: None. M.Salehi: None.