Differences in Glucose Metabolism Among Women With Spinal Cord Injury May Not Be Fully Explained by Variations in Body Composition

Arch Phys Med Rehabil, 2019 · DOI: 10.1016/j.apmr.2018.08.191 · Published: June 1, 2019

Spinal Cord Injury Endocrinology Physiology

Simple Explanation

This study looked at how women with spinal cord injuries (SCI), specifically those with paraplegia and tetraplegia, process glucose compared to women without SCI. The researchers wanted to see if differences in body composition, like muscle and fat mass, could fully explain any differences in glucose metabolism between the groups. The study found that women with tetraplegia had impaired glucose metabolism compared to the other groups, and that these differences weren't completely explained by body composition alone.

Study Duration

Not specified

Participants

42 women: 8 tetraplegic SCI, 14 paraplegic SCI, 20 able-bodied

Evidence Level

Cross-sectional study

Key Findings

1
Women with tetraplegia had higher glucose, insulin, and C-peptide concentrations at minute 120 during the oral glucose tolerance test (OGTT) compared to women with paraplegia and able-bodied women, even after adjusting for total body lean mass and percentage fat mass.
2
Women with tetraplegia had lower insulin sensitivity index (ISI) compared to able-bodied women, even after adjusting for total body lean mass and percentage fat mass.
3
Adjusting for visceral fat and total body lean mass, the glucose, insulin, and C-peptide concentrations at minute 120 remained higher in tetraplegic women compared to paraplegic and able-bodied women. Women with tetraplegia also had lower ISI than able-bodied women.

Research Summary

This study investigated glucose metabolism differences among women with paraplegic and tetraplegic spinal cord injury (SCI) compared to able-bodied (AB) women, adjusting for body composition differences. The study found that impaired glucose metabolism in women with tetraplegia wasn't fully explained by differences in fat mass and lean mass, suggesting other contributing factors. The findings highlight the need to identify additional explanations for injury level-associated metabolic impairment, such as autonomic nervous system alterations and brown adipose tissue function.

Practical Implications

Further Research

Future studies should explore other factors like autonomic nervous system function and brown adipose tissue's role in glucose metabolism in individuals with tetraplegia.

Targeted Interventions

Research focusing on metabolism in women with SCI may inform the development of tailored interventions (nutritional, lifestyle) to protect them from metabolic diseases.

Comprehensive Assessment

Fasting glucose concentration alone may not be an adequate indicator for diabetes diagnosis in women with SCI; OGTT and/or hemoglobin A1c may be better options.

Study Limitations

1
Fat mass was not distinguished by its distribution (eg, of intra- vs intermuscular vs subcutaneous; leg vs trunk vs arm).
2
Due to the small sample size, the study was limited to 2 covariates in the ANCOVA model, potentially overlooking the effects of other factors like injury duration, physical activity, and menopausal status.
3
The unexpected positive correlation between TBLM and insulin/glucose concentrations at min 120 during OGTT and Matsuda index requires further investigation, though sensitivity analysis did not change the study's conclusions.

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