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Table 1 Features of studies included in the final review

From: Effects of diabetes mellitus on amyotrophic lateral sclerosis: a systematic review

Authors, Year of publication

Country setting

Design period of study

Population characteristics

ALS diagnostic criteria

Diabetes mellitus and pre-diabetes states diagnostic criteria

Outcomes of interest

Comments including association between DM and risk of ALS onset, progression or survival

Jawaid [7], 2010

USA Hospital-based

Case–control

N: 274

El Escorial criteria

Not provided

Rate of progression beta coefficient (95% CI): -0.07 (-2.40-0.74), P =0.30

Adjustment performed for possible confounders including BMI change, gender, APoE genotype and Site of onset,

  

1999-2004

Age: 52y

  

Survival beta coefficient (95% CI) 0.10 (-0.93-3.49) P =0.25

 
   

M: 171

    
   

Patient with pre-morbid DM were compared with patients without pre-morbid DM

    

Jawaid [8], 2010

USA Hospital-based

Retrospective Case–control 1984-2007

Cases (ALS with pre-morbid DM):

El Escorial criteria

Diabetes mellitus

Age of onset in years: ALS with DM 60.3 vs. ALS without DM: 56.3 (p < 0.02)

Adjustment performed for possible confounders including gender and site of onset

   

N: 175

 

Two FBG ≥ 126 mg/dl or two RBG ≥ 200 mg/dl at or before the time of ALS diagnosis.

Rate of progression (AALS/month): ALS with DM 3.58 vs. ALS without DM: 3.01 (p: NS)

 
   

Age: 60y

  

Survival (years): ALS with DM: 3.60 vs. ALS without DM 3.04 (p: NS)

 
   

M: 62

    
   

Control (ALS without pre-morbid DM):

    
   

N: 2196

    
   

Age: 56y

    
   

M: 66

    

Pradat [9], 2010

France Hospital-based

Case–control

ALS:

El Escorial criteria

75 g OGTT

Prevalence of IGT in ALS vs. control (33% vs. 9.5% p =0.13)

OGTT compared between ALS patients and controls.

   

N: 21 (including 7 with IGT)

 

DM: FPG > 7.0 mmol/l or the 2-h post-load blood glucose concentration > 11.0 mmol/l.

Disease duration ALS with IGT vs. ALS without IGT (17 months vs. 20 months, p = 0.62),

No adjustment performed for possible confounders with IGT vs. ALS without IGT (17 months vs. 20 months, p = 0.62),

   

Age: 53y

 

IFPG: FPG between 6.1 and 7.0 mmol/l.

ALSFRS ALS with IGT 35 months vs. ALS without IGT 35 months, p = 0.89)

 
   

M: 86%

 

IGT: FPG < 7.0 mmol/l and 2-h blood glucose of 7.8-11.0 mmol/l

  
   

Control (non ALS):

    
   

N: 21

    
   

Age: 53y

    
   

M: 86%

    

Ionacescu [10], 1968

Romania Hospital based

Cross-sectional

N: 18 participans with ALS

Clinical diagnosis: signs of peripheral motor neuron disease in upper and lower limbs + pyramidal signs

Not provided

Abnormal OGTT: 50%

 
   

Age: 52y

  

Exaggerated sensitivity to insulin: 61%

 
   

M: 10

    

Koerner [12], 1976

USA Hospital-based

Retrospective Cross sectional

N: 34 participants with ALS

NA

USPHS criteria/100 g glucose load:

56% of ALS patient had an IGT or DM

Authors reported that the frequency of IGT and DM in ALS participants was higher than in other Asian pacific regions and USA

     

IGT: 2-hour post glucose load > mean + 2SD

  
   

Age: NA

    
   

M: NA

    

Harno [11], 1984

Finland Hospital based

Case–control

Cases:

Clinical and ENMG signs of lower motor neuron disease. Signs of upper motor neuron disease could be present

Diabetes: FPG of ≥140 mg/dL (7.8 mmol/L) or a 2-hour PG ≥ 200 mg/dL in an OGTT

Diabetes:

No adjustment for possible confounders

   

N: 21

 

IGT: FPG <7.8 mmol/l, PG-1 h >11.1 mmol/l, PG-2 h 7.8-11.0 mmol/l)

Case: 5%

 
   

Age: 59y

 

PG-1 h >11.1 mmol/l, PG-2 h 7.8-11.0 mmol/l)

Control: 10%

 
   

M: 14

  

OR = 0.45 (95% CI: 0.03-8.02)

 
   

Control

  

Abnormal OGTT:

 
   

N: 10

  

Case: 19%

 
   

Age: 61y

  

Control: 20%

 
   

M:2

  

OR = 0.94 (95% CI: 0.14-6.25)

 

Armon [13], 1991

USA Population-based

Retrospective Case–control 1925-87

N: 45

NA

Not provided “Diabetes as diagnosed and treated by physicians”

Diabetes:

No adjustment for possible confounders

   

Age: 68y

  

OR = 1 (0.29-3.5)

 
   

M:51%

  

Case: 13%

 
   

Controls

  

Control: 13%

 
   

N: 90

    
   

Age: NA

    
   

M: NA

    
  1. ALS: Amyotrophic lateral sclerosis, DM: Diabetes mellitus, N: sample size, M: male sex, 95% CI: 95% confidence interval, BMI: Body mass index, FBG: Fasting blood glucose, RBG: Random blood glucose, FPG: Fasting plasma glucose, OGTT: Oral glucose tolerance test, IGT: Impaired glucose tolerance test, IFPG: Impaired fasting plasma glucose, PG: Plasma glucose, ENMG: Electroneuromyography, ALSFRS: Amyotrophic lateral sclerosis functional rating scale, AALS: Appel amyotrophic lateral sclerosis score, RR: relative risk, NA: Not available, y: years.