A clinical trial is underway to investigate the causes of diabetes and obesity in individuals with spinal cord injury and the potential benefits of semaglutide. The $3 million study, funded by the National Institutes of Health (NIH), aims to address the significant health disparities in managing metabolic conditions in this population.
Addressing a Critical Unmet Need
People with spinal cord injuries are 150% more likely to develop type 2 diabetes compared to the general population, often at a younger age. Despite this increased risk, optimal treatment strategies for diabetes and related cardiometabolic complications in this population remain unclear. "This is one population in which they are susceptible to be more obese and having worse diabetes risk and are not being treated with optimal drugs, one of them being the GLP1-RA," said Marzieh Salehi, MD, MS, the trial's primary investigator and professor of medicine at UT Health San Antonio.
Semaglutide's Potential Role
Semaglutide, a glucagon-like peptide 1 receptor agonist (GLP-1 RA), is a potent treatment for weight loss and glycemic control. It works by stimulating insulin secretion, lowering glucagon secretion, delaying gastric emptying, and suppressing appetite. While semaglutide has been extensively studied in able-bodied individuals with type 2 diabetes, its effects in patients with spinal cord injury are largely unknown.
Trial Design and Objectives
The trial will assess the effects of 24-week administration of semaglutide on glucose tolerance and insulin action, as well as fat and lean mass. Participants will include men and women with spinal cord injury and type 2 diabetes who are taking metformin. Researchers will also monitor how participants tolerate semaglutide and investigate its effect on bone density.
Investigating Underlying Mechanisms
Beyond glucose control and body mass reduction, the study will explore the underlying pathways and mechanisms of semaglutide's glucose regulatory effects. "In these studies, with sometimes over 1,000 able-bodied people, very few studies look at underlying pathways and mechanisms of glucose regulatory effects of these drugs. They have been focused on cardiovascular, and rightfully so, but there is lots to be learned beyond that," Salehi noted. The findings are expected to provide insights into the pathophysiology of diabetes in individuals with spinal cord injury and inform treatment guidelines for this vulnerable population.
