Does TBI Increase Susceptibility to Diabetes and Can This Be Prevented by Glucocorticoid Blockade?

Blast-related mild traumatic brain injury (mTBI) is widespread amongst service members and veterans who served in Iraq and Afghanistan. TBI has many long term adverse health consequences as summarized in a recent report by the Institute of Medicine1. However, it remains unclear if TBI increases the susceptibility to diabetes and other metabolic diseases. Given the tremendous impact that diabetes and metabolic diseases have on the quality of life and morbidity by fueling cardiovascular disease, cancer, impaired cognition and reducing life expectancy, it is important to establish if mTBI can indeed cause metabolic disease and if so, through which mechanisms. Here we tested if blast induced TBI impairs metabolism in a rats independent of food intake. In well controlled studies we established that indeed blast induced TBI causes profound and long lasting glucose intolerance. Importantly we were able to completely reverse this glucose intolerance through the treatment with an SGLT2 inhibitor, a commercially available diabetes drug which also prevented the brain inflammation. The biggest impact of these studies lie in the realization that TBI impairs metabolic control and increases the risk for type 2 diabetes. Secondly, they give hope to those that may suffer from metabolic disease and have TBI as we have begun to identify drugs that seem to be promising in treating TBI induced metabolic disease.