Prevalence, association, and associated factors of diabetes mellitus in individuals with spinal cord injury: a systematic review and meta-analysis.

Abstract

Systematic review and meta-analysis. To systematically evaluate the prevalence of diabetes mellitus (DM) among individuals with spinal cord injury (SCI), assess the association between SCI and DM compared with non-SCI populations, and synthesize evidence on associated factors within SCI populations. Observational studies from PubMed, Embase, Cochrane Library, CINAHL, and ProQuest Dissertations & Theses Global, published up to August 2025 were identified. Two reviewers independently screened articles, extracted data, and assessed study quality using the Newcastle-Ottawa Scale (NOS) and the Agency for Healthcare Research and Quality (AHRQ) criteria. Heterogeneity was assessed using the I² statistic, and sensitivity, subgroup, and publication bias analyses were conducted. Ten studies with 76,062 individuals with SCI were included, comprising six cohort and four cross-sectional studies. The pooled prevalence of DM among individuals with SCI was 12% (95% CI, 5-20%). SCI was associated with an approximately two-fold higher odds of DM compared with non-SCI populations (OR = 2.03, 95% CI, 1.30-3.16). Subgroup analyses suggested that study region and sample size contributed to heterogeneity in prevalence estimates. Within SCI populations, meta-analysis identified male sex (OR = 1.22, 95% CI, 1.05-1.40) and Black race (OR = 1.62, 95% CI, 1.24-2.10) as significant associated factors with DM. These findings highlight the importance of systematic DM screening, risk-stratified management, and integration of metabolic monitoring into long-term SCI care, while underscoring the need for large, prospective, and geographically diverse studies.