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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.