ALS Nexus 2026: People with diabetes may have lower ALS risk, study says
Clarifying the link could guide future ALS prevention, early intervention
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- New research indicates that people with diabetes may have a lower risk of developing ALS compared to those without diabetes.
- Longer reported diabetes duration and insulin treatment were associated with a reduction in the risk of developing ALS.
- Clarifying the link could contribute to future ALS prevention strategies and early intervention approaches.
People with diabetes may be less likely to develop amyotrophic lateral sclerosis (ALS) than those without diabetes, according to findings detailed in a poster presented at the ALS Nexus conference.
The study also found that people with a longer reported duration of diabetes and those receiving insulin as a treatment for diabetes had a lower risk of developing ALS.
“Our study suggests that diabetes may influence ALS susceptibility,” researchers wrote in the poster’s abstract.
The poster presented at the conference, which is being held Aug. 23-26 in Orlando, Florida, and virtually, is titled “Are Individuals with Diabetes Less Likely to Develop Amyotrophic Lateral Sclerosis?”
Study integrates demographic, lifestyle information into models
In ALS, the nerve cells that control movement progressively die, leading to a variety of symptoms. Researchers have identified several potential risk factors for developing ALS, but they don’t know exactly what causes the disease.
Previous work has linked diabetes to a lower ALS risk, although the precise relationship remains unclear. Diabetes is a metabolic disease, meaning it affects the way the body produces and uses energy. Researchers have proposed several possible explanations for the association, including changes in energy metabolism and other molecular processes that could potentially influence the development of ALS.
While several population-based studies have analyzed the risk of ALS among people with and without diabetes, these have limitations. In particular, some lacked data on demographics and lifestyle factors, which could influence ALS risk and diabetes risk independently.
In the present study, the team integrated demographic and lifestyle information into models of the relationship between ALS and diabetes. The study included participants from six large population health studies. Each study started with a health questionnaire and then followed participants until they died, developed ALS, were lost to follow-up, or remained in the study for 15 years.
Diabetes group had lower risk of developing ALS
More than 1.1 million individuals, who were all free of ALS at the start of the studies, were selected to be included in the analyses. They had a median age of 62 years and more than half (55.2%) were female.
When comparing all the participants who reported a diabetes diagnosis when the studies started to participants without diabetes, the cumulative incidence of ALS was comparable for several years. However, over time, the gap in ALS incidence between the two groups widened.
After statistically adjusting demographic and lifestyle factors, researchers found that 14 per 10,000 people in the group without diabetes developed ALS within 15 years. In comparison, 9.8 per 10,000 people in the diabetes group developed ALS within the same time frame, corresponding to a 30% lower risk.
For additional statistical control, the researchers also built a model that adjusted for demographics, lifestyle factors, and death censoring. Death censoring occurs in population health studies when participants die before the study ends, limiting the follow-up period. Because diabetes may increase the likelihood of death before an ALS diagnosis, death censoring can complicate the analysis of the relationship between the two conditions.
However, the model that accounted for death censoring yielded similar findings to the previous models.
“The consistency across adjustment strategies suggests this association is not explained by measured lifestyle factors or differential censoring due to death,” the team wrote.
Risk lowest among people with diabetes treated with insulin
Certain aspects of diabetes were also found to be associated with ALS risk. For example, people who had received a diabetes diagnosis more than six years before entering one of the studies had a 38% lower risk of developing ALS compared with those without diabetes. The risk was lowest among people with diabetes who received treatment with insulin — their risk of developing ALS was 44% lower than that of people in the group without diabetes.
The team also repeated the analysis in a smaller group of participants using an alternative statistical strategy. They matched each participant with diabetes to a participant without diabetes who had similar demographic and lifestyle features. Again, the reduction in ALS risk remained consistent.
Clarifying the metabolic pathways underlying this association could contribute to ALS prevention or early intervention.
The study had several limitations. Participants only answered questions about diabetes diagnosis and lifestyle when they entered each of the studies. This meant that researchers couldn’t account for new diagnoses or changes in lifestyle. There may have also been other factors that influenced the risk of diabetes or ALS and weren’t accounted for.
The team noted that future studies could attempt to determine the biological relationship between diabetes and ALS risk.
“Clarifying the metabolic pathways underlying this association could contribute to ALS prevention or early intervention,” they wrote.
Note: The ALS News Today team is providing virtual coverage of the ALS Nexus Aug. 23-26. Go here to see the latest stories from the conference.
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