Neurogenic Obesity-Induced Insulin Resistance and Type 2 Diabetes Mellitus in Chronic Spinal Cord Injury

Top Spinal Cord Inj Rehabil, 2021 · DOI: 10.46292/sci20-00063 · Published: January 1, 2021

Simple Explanation

Spinal cord injury (SCI) can lead to significant changes in body composition and cardiometabolic health, often resulting in a sedentary lifestyle and the accumulation of adipose tissue, which can lead to neurogenic obesity. Neurogenic obesity can cause chronic inflammation that impacts glucose homeostasis. Adipose tissue releases proinflammatory molecules that interfere with insulin signaling pathways, leading to insulin resistance and type 2 diabetes. Diagnosing prediabetes and type 2 diabetes in individuals with SCI can be challenging because standard tests may not correlate well. Additional research is needed to determine the most accurate diagnostic methods for this population.

Study Duration

Not specified

Participants

Persons with Spinal Cord Injury

Evidence Level

Not specified

Key Findings

1
Individuals with SCI are at a higher risk of developing insulin resistance and type 2 diabetes mellitus (T2DM) compared to those without SCI.
2
Higher levels of visceral, subcutaneous, and liver adipose tissue are associated with dysfunctional cardiometabolic profiles in individuals with SCI.
3
Higher levels of spinal cord injury (tetraplegia) are associated with negative effects on carbohydrate profiles, including elevated glucose and insulin concentrations.

Research Summary

This review examines insulin resistance and T2DM after SCI, noting the high prevalence of these conditions in the SCI population and the potential inadequacy of current assessment methods. The standard diagnostic criteria for T2DM may underestimate the true occurrence of carbohydrate metabolism disorders in persons with SCI, necessitating further research in this area. Lifestyle interventions involving diet and exercise can be effective in treating and preventing insulin resistance and T2DM in individuals with chronic SCI.

Practical Implications

Improved Screening

There is a need for improved screening methods tailored to the SCI population to accurately diagnose prediabetes and T2DM.

Targeted Interventions

Lifestyle interventions, including diet and exercise, should be implemented to mitigate neurogenic obesity and improve cardiometabolic health in individuals with SCI.

Personalized Care

Healthcare providers should consider the level and completeness of injury when assessing and managing carbohydrate metabolism disorders in persons with SCI.

Study Limitations

1
The review acknowledges that current diagnostic methods for carbohydrate metabolism disorders may underestimate the true occurrence in persons with SCI.
2
The precise contribution of autonomic nervous system dysfunction to glucose intolerance and insulin resistance requires further investigation.
3
The effectiveness of specific exercise modalities on insulin sensitivity and glucose transport in individuals with SCI warrants additional research.

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