Continuous glucose monitoring of postprandial and 24-hour responses in individuals with spinal cord injury

Context/objective Spinal cord injury (SCI) is associated with autonomic and metabolic alterations that may impair glucose regulation. However, postprandial and 24-h glycemic dynamics in this population remain poorly understood. This study compared 5-h controlled postprandial and 24-h continuous glucose monitoring (CGM)-derived glycemic responses, including free-living monitoring, in individuals with and without SCI. Design Comparative acute experimental study. Setting University-based laboratory setting. Participants Twenty-nine individuals with SCI and 20 individuals without SCI were included in the 5-h analysis. Participants with SCI were wheelchair users at least 1 year post-injury, and all participants had no diagnosis of type 2 diabetes and were not using glucose-lowering medications. The 24-h analysis included 21 individuals with SCI and 16 individuals without SCI who met the 24-h CGM completeness criterion. Interventions Consumption of a standardized mixed meal followed by 5 h of seated rest, defined as the controlled postprandial period. The subsequent 19 h were monitored under free-living conditions. Outcome measures CGM-derived area under the curve (AUC), mean glucose, glycemic variability indices, and time to peak glucose. Results During the 5-h controlled postprandial period, most CGM-derived outcomes, including AUC, mean glucose, and glycemic variability indices, were comparable between groups. However, the postprandial glucose response over time showed a significant group × time interaction (p < 0.001), and individuals with SCI had a shorter time to peak glucose than individuals without SCI [45 (30-60) vs. 75 (60-138.8) min; p < 0.001]. In the exploratory 24-h analysis, most CGM-derived outcomes were comparable between groups. Conclusion Individuals with SCI had a shorter CGM-derived time to peak glucose following a standardized mixed meal, despite largely comparable overall 5-h glycemic exposure and variability. Further CGM studies are needed to clarify the physiological relevance of postprandial glucose dynamics under both controlled and free-living conditions.