Strong association of lumbar disk herniation with diabetes mellitus: a 12-year nationwide retrospective cohort study

Jing-Xing Li; Tzu-Ju Hsu; Shu-Bai Hsu; Yu-Hsiang Lin

doi:10.3389/fendo.2023.1260566

Strong association of lumbar disk herniation with diabetes mellitus: a 12-year nationwide retrospective cohort study

Front Endocrinol (Lausanne). 2023 Nov 2:14:1260566. doi: 10.3389/fendo.2023.1260566. eCollection 2023.

Authors

Jing-Xing Li^{1

2

3}, Tzu-Ju Hsu⁴, Shu-Bai Hsu^{5

6}, Yu-Hsiang Lin^{7

8}

Affiliations

¹ Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
² School of Medicine, China Medical University, Taichung, Taiwan.
³ Graduate Institute of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University, Taipei, Taiwan.
⁴ Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
⁵ College of Medicine, China Medical University, Taichung, Taiwan.
⁶ Department of Nursing, China Medical University Hospital, Taichung, Taiwan.
⁷ School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁸ Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan.

Abstract

Background: Despite reports on the association between diabetes mellitus (DM) and lumbar disk herniation (LDH), large-scale, nationwide studies exploring this relationship are lacking. We aimed to examine the profiles of DM in individuals with LDH and explore the potential mechanisms underlying the development of these disorders.

Methods: This retrospective, population-based study was conducted between 2008 and 2019 using data from the National Health Insurance (NHI) research database in Taiwan. The primary outcome was the date of initial LDH diagnosis, death, withdrawal from the NHI program, or end of the study period.

Results: In total, 2,662,930 individuals with and 16,922,546 individuals without DM were included in this study; 719,068 matched pairs were established following propensity score matching (1:1 ratio) for sex, age, comorbidities, smoking, alcohol consumption, antihyperglycemic medications, and index year. The adjusted risk for developing LDH was 2.33-fold (95% confidence interval: 2.29-2.37; P<0.001), age-stratified analysis revealed a significantly greater risk of LDH in every age group, and both males and females were approximately twice as likely to develop LDH in the DM compared with non-DM cohort. Individuals with DM and comorbidities had a significantly higher risk of developing LDH than those without, and the serial models yielded consistent results. Treatment with metformin, sulfonylureas, meglitinides, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, or alpha-glucosidase inhibitors was associated with a more than 4-fold increased risk of LDH in the DM cohort. DM was strongly associated with the long-term development of LDH; over the 12-year follow-up period, the cumulative risk of LDH was significantly higher in patients with than without DM (log-rank P<0.001).

Conclusion: DM is associated with an increased risk of LDH, and advanced DM may indicate a higher risk of LDH.

Keywords: anti-diabetic medications; chronic back pain; diabetes mellitus; intervertebral degenerative disk disease; lumbar disk herniation.

MeSH terms

Diabetes Mellitus* / drug therapy
Diabetes Mellitus* / epidemiology
Female
Humans
Hypoglycemic Agents / therapeutic use
Intervertebral Disc Displacement* / complications
Intervertebral Disc Displacement* / epidemiology
Male
Metformin* / therapeutic use
Retrospective Studies

Substances

Hypoglycemic Agents
Metformin

Grants and funding

The author(s) declare no financial support was received for the research, authorship, and/or publication of this article.