Preliminary observations on the administration of a glucagon-like peptide-1 receptor agonist on body weight and select carbohydrate endpoints in persons with spinal cord injury: A controlled case series

To describe the effect of semaglutide, a glucagon-like peptide-1 (GLP-1) agonist, to reduce body weight and improve glycemic control in overweight or obese individuals with spinal cord injury (SCI). Open-label, randomized drug intervention case series. This study was performed at James J. Peters VA Medical Center (JJP VAMC) and Kessler Institute for Rehabilitation (KIR). Five individuals with chronic SCI meeting criteria for obesity and abnormal carbohydrate metabolism. Administration of semaglutide (subcutaneously once per week) versus no treatment (control) for 26 weeks. Change in total body weight (TBW), fat tissue mass (FTM), total body fat percent (TBF%), and visceral adipose tissue volume (VAT vol ) was determined at baseline and after 26 weeks using Dual energy X-ray absorptiometry; fasting plasma glucose (FPG) concentration and serum glycated hemoglobin (HbA1C) values were obtained at the same two time points. In 3 participants, after 26 weeks of semaglutide administration, TBW, FTM, TBF%, and VAT vol decreased, on average, by 6, 4.4 kg, 1.7%, and 674 cm 3 , respectively. In addition, values for FPG and HbA1c decreased by 17 mg/dl and 0.2%, respectively. After 26 weeks of observation in the 2 control participants, TBW, FTM, TBF% and VAT vol increased on average by 3.3 , 4.5 kg, 2.5%, and 991 cm 3 , respectively. The average values for FPG and HbA1c also increased by 11 mg/dl and 0.3%, respectively. Administration of semaglutide for 26 weeks resulted in favorable changes in body composition and glycemic control, suggesting a reduced risk for the development of cardiometabolic disease in obese individuals with SCI. Trial registration: ClinicalTrials.gov identifier: NCT03292315.