24 - Are Individuals with Diabetes Less Likely to Develop Amyotrophic Lateral Sclerosis? - ALS Nexus 2026. Online registration by Cvent

Flores-Torres, M. H., O’Reilly, É., Cortese, M., Patel, A., Park, Y., Schwarzschild, M. A., Szmulewicz, A., Bjornevik, K., & Ascherio, A.

Presented by: Mario Flores Torres, M.D., Ph.D., Harvard T.H. Chan School of Public Health

Objective: We prospectively evaluated the association between diabetes and risk of amyotrophic lateral sclerosis (ALS).

Methods: We pooled data from 6 prospective US cohorts and included participants free of ALS at baseline with information on physician-diagnosed diabetes. Risks and risk ratios (RRs) of ALS over 15 years were estimated for participants with and without diabetes in 2 complementary populations: (1) an unmatched cohort including all eligible participants, adjusted for confounding using inverse probability weighting, and (2) a 1:1 matched cohort in which participants with diabetes were matched to participants without diabetes on key confounders. Analyses in the unmatched cohort examined diabetes duration and insulin-treated diabetes.

Results: The unmatched cohort included 1,233,272 participants (median age, 62 years [IQR, 56–66]; 55.2% female), and 1,425 developed ALS during 15 years of follow-up. The matched cohort included 93,188 participants with diabetes matched to 93,188 without diabetes; 198 developed ALS. In the unmatched cohort, the 15-year risk of ALS was 9.8 per 10,000 persons (95% CI, 7.5–12.6) among participants with diabetes and 14.0 per 10,000 persons (95% CI, 13.2–14.7) among those without diabetes (RR, 0.70; 95% CI, 0.53–0.92). Similar estimates were observed in the matched cohort. The magnitude of this association decreased with shorter follow-up and increased with diabetes duration. Risk estimates were lowest among participants with insulin-treated diabetes (RR, 0.56; 95% CI, 0.07–1.25).

Conclusion: Our study suggests that diabetes may influence ALS susceptibility. Clarifying the metabolic pathways underlying this association could contribute to ALS prevention or early intervention.