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.
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.
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.
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.
Copyright © 2012 Elsevier Inc. All rights reserved.
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]
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.