Diabetes Mellitus-A Risk Factor for the Development of Lumbar Disc Degeneration: A Retrospective Study of an Indian Population

Study Design: A retrospective study. Objectives: To determine the association between type-2 diabetes mellitus (T2DM) and the severity of lumbar disc degeneration disease (LDDD). Methods: We included 199 patients with low back pain (LBP) who visited our hospital from 2016 to 2018. All patients were divided into 3 groups as per inclusion criteria. Group A, patients without DM (n = 75); group B, patients with controlled DM (n = 72); and group C, patients with uncontrolled DM (n = 52). The patients were further subdivided into group B1, DM duration <= 10 years (n = 38); group B2, DM duration >10 years (n = 34); group C1 DM duration <= 10 years (n = 28); and group C2, DM duration >10 years (n = 24). Sex, age, body mass index, occupation, smoking history, alcohol use, and duration of T2DM were recorded. The severity of LDDD was evaluated using the 5-level Pfirrmann grading system. Operated patients' disc materials were sent for histological examination. Results: Demographic data showed no difference among groups (P> 0.5), except age. Patients with DM showed more severe disc degeneration compared with patients without DM. The average Pfirrmann scores between groups A and B1 had no difference; groups B2, C1, and C2 showed higher average Pfirrmann scores than group A (P< 0.05). Groups B2 and C2 showed higher average Pfirrmann scores than groups B1 and C1 (P< 0.05). Groups C1 and C2 showed higher average Pfirrmann scores than groups B1 and B2 (P< 0.05). The severity of LDDD was significantly related to DM duration in both groups B and C (P< 0.05). DM groups showed increased disc apoptosis and matrix aggrecan fragmentation, disc glycosaminoglycan content and histological analysis were significantly different; the results are similar to Pfirrmann score results. Conclusions: DM duration >10 years and uncontrolled DM were risk factors for LDDD.