Diagnosis and Management of Cardiometabolic Disease After Spinal Cord Injury: Identifying Gaps in Physician Training and Practices

Authors

Chinenye Christa Nnoromele
Du Pham
Felicia Skelton
Ryan Solinsky

Publication Date

1-1-2025

Journal

The Journal of Spinal Cord Medicine

DOI

10.1080/10790268.2023.2235744

PMID

37534921

PMCID

PMC11749254

PubMedCentral® Posted Date

8-3-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Spinal Cord Injuries, Humans, Cardiovascular Diseases, Practice Patterns, Physicians', Physicians, Male, Female, Metabolic Diseases, Spinal cord injury (SCI), Cardiometabolic disease, Screening practices, Cardiometabolic disease guidelines, Risk management, Medical training

Abstract

CONTEXT: Cardiometabolic disease (CMD) frequently occurs in individuals with spinal cord injury (SCI), with growing awareness surrounding the expansive scope of this problem. As CMD has significant morbidity and mortality, early guidelines-based screening and management have been established. However, the extent to which these guidelines have been adopted are unclear.

OBJECTIVE: Describe physicians' screening and management pattern for CMD in patients with SCI, as compared to SCI-specific CMD screening guidelines, and elucidate variables linked to screening and management patterns.

METHODS: SCI medicine-boarded physicians were surveyed on screening timing for CMD following acute SCI, along with their practice pattern and comfort level managing common CMD risk factors.

RESULTS: Of the forty-seven SCI medicine physicians that responded, 62% felt the ideal timing for CMD screening is 6 months after the acute injury. Of these same physicians, few were screening for insulin resistance and lipid dysregulation prior to 6 months after injury. In addition, less than half felt comfortable writing new prescriptions for anti-glycemic and anti-lipid medications. Furthermore, no association was found between the amount of CMD education with screening or management patterns. Finally, VA-based providers were more likely to screen for CMD within 6 months of injury and were more comfortable managing/starting anti-glycemic medications and statins.

CONCLUSIONS: Despite the presence of SCI-specific CMD guidelines, gaps in screening and management practices still exist, most notably with insulin resistance and lipid dysregulation. VA-based providers generally screen and manage CMD risk factors more effectively, and further CMD education could consider emulating VA training modules.