• Stella Maris Fabiane, Kirsten J Ward, James C Iatridis, and Frances M K Williams.
• Department of Twin Research, King's College London, St Thomas' Hospital Campus, 4th Floor South Wing Block D, Westminster Bridge Road, London, SE1 7EH, UK.
• Eur Spine J. 2016 Sep 1; 25 (9): 271627202716-20.

PurposeLDD is an important cause of low back pain. Many people believe there is an adverse influence of type 2 diabetes (T2D) on lumbar intervertebral disc degeneration (LDD). We examined a population sample for epidemiological evidence of association.MethodsTwin volunteers from the TwinsUK cohort having spine magnetic resonance (MR) scans coded for LDD and information about T2D were investigated in two ways. First, as a population sample and second as a cotwin case control study in twin pairs discordant for T2D. Other risk factors for LDD considered were age, body-mass index (BMI), smoking, and alcohol.ResultsIn 956 twin volunteers T2D had a prevalence of 6.6 %. LDD score was higher in T2D twins (14.9 vs 13.1 p = 0.04) but was not an independent risk factor if the influence of age and BMI were included in the model. Discordant twin analysis (n = 33 pairs) showed no significant difference in LDD between twins having T2D and their unaffected cotwins.ConclusionsTwins having T2D did manifest higher LDD scores but the effect was abrogated once BMI was included in multivariable analysis, showing it is not an independent risk factor for LDD. The population study had 80 % power at 0.1 significance level to detect a difference of 1.8 in LDD score (range of 0-60), so if there is an effect of T2D on LDD, it is likely to be small.

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