The effect of residual neurological deficit on oral glucose tolerance in persons with chronic spinal cord injury

Abstract

Study design: Oral glucose tolerance testing was performed prospectively in 201 subjects with spinal cord injury (SCI). The dependent variables included the values from the oral glucose tolerance test (glucose and insulin) and diagnostic classi®cation (i.e., diabetes mellitus, impaired glucose tolerance, normal glucose tolerance); the independent variables consisted of study group, gender, ethnic group, age, age at onset of SCI, duration of injury, and anthropometric measurements. Objective: To determine the potential e ects of level and completeness of SCI on oral glucose tolerance testing. In addition, the e ects of gender ethnicity, age, age at onset of SCI, duration of injury, and anthropometric measurements on glucose tolerance were investigated. Setting: Subjects with chronic SCI were recruited during their annual physical examination at the Comarr Spinal Injury Clinic at Rancho Los Amigos Medical Center, Downey, California. Methods: An oral 75 g glucose load was administered after an overnight fast. Serum glucose was determined by autoanalyzer and plasma insulin levels, by radioimmunoassay. The results are reported as mean plus or minus standard error of the mean (mean+SEM). Analysis of variance (ANOVA) applying a Sche e' post hoc F ratio was used for the continuous variables. Chi-squared analyses were performed to determine di erences between the groups and among the subgroups for per cent distribution. Linear regression analyses were performed between variables of interest. Stepwise regression analyses were used to predict peak serum glucose concentration and peak plasma insulin level from potential determinants. Results: The total group consisted of 169 men with a mean age of 38+0.80 (range=20 ± 73) years and 32 women with a mean age of 44+2.13 (range =20 ± 72) years. The distribution by ethnicity for the total group with SCI consisted of 114 (57%) Latino, 54 (27%) white, and 28) 14%) African American individuals. There was no signi®cant di erence in ethnic distribution among the subgroups for neurological de®cit. Subjects were grouped by tetraplegia (Tetra; n=81) or paraplegia (Para; n=120) and by subgroup for degree of neurological de®cit: complete Tetra (n=56), incomplete Tetra (n=25), complete Para (n=84), and incomplete Para (n=36). Of the total group, 27 subjects (13.4%) had diabetes mellitus and 56 (28.8%) had impaired glucose tolerance. Signi®cantly more subjects in the complete Tetra group were classi®ed with a disorder of carbohydrate metabolism than in the other neurological de®cit subgroups (73 vs 44%, 24% and 31%, respectively for level of decreasing neurological de®cit; X 2 =36.9, P50.0001). The complete Tetra group had signi®cantly higher serum glucose concentrations at 60 min, 90 min, and 120 min and serum insulin concentration at 90 and 120 min compared with the other neurological subgroups (P50.05 for each time point). No di erences for plasma glucose were evident between men and women, however, plasma insulin levels were signi®cantly higher for men at the intermediate time points (30...

Glucose tolerance and physical activity level in people with spinal cord injury

“…This is an exciting finding given that physical activity level is modifiable, and that disordered glucose metabolism is disproportionately prevalent in people with SCI compared with the ablebodied. 1,2 Previous studies in people with SCI have shown relationships between glycemia and neurological lesion level 3 and between fasting glucose and physical activity levels. 9 However, because lesion level may be associated with physical activity level, 11 it was not clear in these studies whether the influence of physical activity on disordered carbohydrate metabolism was independent of lesion level.…”

“…1,2 It has been suggested that the extent of neurological impairment after SCI is an important determinant of these impairments; participants with complete tetraplegia (TETRA) had higher levels of serum glucose and plasma insulin during a 2-h oral glucose tolerance test (OGTT) and higher incidence of IGT or diabetes than participants with either incomplete TETRA or complete or incomplete paraplegia (PARA). 3 The suggestion that greater neurological deficit is associated with poorer glucose tolerance may be explained by the consequences of denervation such as skeletal muscle atrophy 4,5 and altered fiber-type proportions, 6,7 with the volume of muscle affected related to level and completeness of the neurological lesion. Skeletal muscle is the major site for insulin-mediated glucose disposal and glucose transport is rate limiting for glucose utilization under most conditions.…”

Long-term body-weight-supported treadmill training and subsequent follow-up in persons with chronic SCI: effects on functional walking ability and measures of subjective well-being

“…These benefits certainly should not be ignored, especially since Type II diabetes and cardiovascular disease are prevalent secondary complications in the SCI population. [28][29][30] In addition to the physiological benefits of BWSTT, this type of therapy carries with it a significant potential to improve subjective well-being. In the present study, significant increases emerged in overall life satisfaction as well as satisfaction with physical function.…”

A review of body mass index and waist circumference as markers of obesity and coronary heart disease risk in persons with chronic spinal cord injury

“…Impaired glucose tolerance, insulin resistance and diabetes occur more frequently in SCI versus able-bodied persons. 15,38,[41][42][43][44][45] Other potential CHD risk factors after SCI include decreased physical activity, psychosocial factors (depression, isolation), and elevated plasma homocysteine and C-reactive protein. 46 Increased fat mass has also been identified as an important risk factor in chronic SCI and weight management is recommended as a key CHD prevention strategy.…”