de Cógáin M et al, 2012: Shock wave lithotripsy and diabetes mellitus: a population-based cohort study

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de Cógáin M et al, 2012: Shock wave lithotripsy and diabetes mellitus: a population-based cohort s...

de Cógáin M et al, 2012: Shock wave lithotripsy and diabetes mellitus: a population-based cohort study

de Cógáin M, Krambeck AE, Rule AD, Li X, Bergstralh EJ, Gettman MT, Lieske JC

Department of Urology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA

Abstract

OBJECTIVE:

To determine if shock wave lithotripsy (SWL) is associated with diabetes mellitus (DM) in a community setting. The pancreas is vulnerable to injury at SWL as evidenced by case studies; thus, concern exists for the development of DM after SWL.

METHODS:

The Rochester Epidemiologic Project was used to identify all Olmsted County, Minnesota residents diagnosed with urolithiasis from 1985 to 2008. New-onset DM
was identified by diagnostic codes and treatment with SWL by surgical codes. Cox proportional hazards models were used to determine the risk of DM after SWL therapy.

RESULTS:

A total of 5287 incident cases of stone formation without pre-existing DM and with ≥3 months of follow-up. After an average follow-up of 8.7 years, 423 patients (8%) were treated with SWL and new-onset DM had developed in 743 (12%). The diagnosis of DM followed SWL in 77 patients. However, no association was evident between SWL and the development of DM before (hazard ratio 0.98, 95% confidence interval 0.76-1.26) or after (hazard ratio 0.92, 95% confidence interval 0.71-1.18) SWL, controlling for age, sex, and obesity.

CONCLUSION:

In the present large, population-based cohort, the long-term risk of developing DM was not increased in persons who underwent SWL to treat their kidney stones.

Comment in Urology. 2012 Feb;79(2):302-3; author reply 303.

Urology. 2012 Feb;79(2):298-302. doi: 10.1016/j.urology.2011.07.1430. Epub 2011 Nov 16

PMID:22088569 [PubMed - in process] PMCID:PMC3274621[Available on 2013/2/1]

Comment

It is of note that the same institution that previously reported an increased risk of diabetes mellitus (and hypertension) based on findings in a retrospective analysis, in this population based cohort study concluded that there is not an increased risk of developing diabetes mellitus as a consequence of the tissue trauma caused by ESWL. This is an observation that also is in line with the reviewer’s clinical experience.

Hans-Göran Tiselius