Guideline for the identification and management of cardiometabolic risk after spinal cord injury: a case of unsubstantiated recommendations

Abstract

The 2018 Guideline for the Identification and Management of Cardiometabolic Risk after Spinal Cord Injury (SCI) represented the first concerted effort to address a cluster of derangements and diseases that are claiming the lives of individuals living with injuries. Its contributors and authors scoured the literature, weighed the validity, importance, and clinical relevance of what data they found, and collaborated in an effort to meaningfully improve the health and lives of people with SCI. However, we are concerned that several of the guideline’s central recommendations—particularly around screening for and detection of glycemic dysregulation and dyslipidemia—have been offered prematurely. In several instances, the authors cite data from studies of people without SCI and, in our opinion, inappropriately apply those findings to support their SCI-specific suggestions. In other instances, they recommend that we employ tests whose usefulness and clinical relevance have yet to be demonstrated among people living with injuries. In short, we fear that the authors have developed clinical guidelines that are inadequately supported by data. This guideline is an extraordinary show of collaboration, and is an important first step toward understanding and treating a number of secondary cardiometabolic effects of SCI. The lack of data underpinning several of its central recommendations—making them, in our opinion, unadoptable—underscores the inadequacy of research in this area and provides a roadmap for future investigative efforts.