Schneider Andrea L C, Selvin Elizabeth, Sharrett A Richey, Griswold Michael, Coresh Josef, Jack Clifford R, Knopman David, Mosley Thomas, Gottesman Rebecca F
Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
Diabetes Care. 2017 Nov;40(11):1514-1521. doi: 10.2337/dc17-1185. Epub 2017 Sep 15.
To examine the associations of prediabetes, diabetes, and diabetes severity (as assessed by HbA and diabetes duration) with brain volumes and vascular pathology on brain MRI and to assess whether the associations of diabetes with brain volumes are mediated by brain vascular pathology.
Cross-sectional study of 1,713 participants in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS) (mean age 75 years, 60% female, 27% black, 30% prediabetes, and 35% diabetes) who underwent 3T brain MRI scans in 2011-2013. Participants were categorized by diabetes-HbA status as without diabetes (<5.7% [reference]), with prediabetes (5.7 to <6.5%), and with diabetes ([defined as prior diagnosis or HbA ≥6.5%] <7.0% vs. ≥7.0%), with further stratification by diabetes duration (<10 vs. ≥10 years).
In adjusted analyses, compared with participants without diabetes and HbA <5.7%, participants with prediabetes and those with diabetes and HbA <7.0% did not have significantly different brain volumes or vascular pathology (all > 0.05), but those with diabetes and HbA ≥7.0% had smaller total brain volume (β -0.20 SDs, 95% CI -0.31, -0.09), smaller regional brain volumes (including frontal, temporal, occipital, and parietal lobes; deep gray matter; Alzheimer disease signature region; and hippocampus [all < 0.05]), and increased burden of white matter hyperintensities (WMH) ( = 0.016). Among participants with diabetes, those with HbA ≥7.0% had smaller total and regional brain volumes and an increased burden of WMH (all < 0.05) compared with those with HbA <7.0%. Similarly, participants with longer duration of diabetes (≥10 years) had smaller brain volumes and higher burden of lacunes (all < 0.05) than those with a diabetes duration <10 years. We found no evidence for mediation by WMH in associations of diabetes with smaller brain volumes by structural equation models (all > 0.05).
More-severe diabetes (defined by higher HbA and longer disease duration) but not prediabetes or less-severe diabetes was associated with smaller brain volumes and an increased burden of brain vascular pathology. No evidence was found that associations of diabetes with smaller brain volumes are mediated by brain vascular pathology, suggesting that other mechanisms may be responsible for these associations.
研究糖尿病前期、糖尿病以及糖尿病严重程度（通过糖化血红蛋白[HbA]和糖尿病病程评估）与脑容量及脑磁共振成像（MRI）上的血管病变之间的关联，并评估糖尿病与脑容量之间的关联是否由脑血管病变介导。
对社区动脉粥样硬化风险神经认知研究（ARIC-NCS）中的1713名参与者进行横断面研究（平均年龄75岁，60%为女性，27%为黑人，30%为糖尿病前期，35%为糖尿病患者），这些参与者在2011 - 2013年接受了3T脑MRI扫描。参与者根据糖尿病 - HbA状态分为无糖尿病（<5.7%[参照组]）、糖尿病前期（5.7%至<6.5%）和糖尿病（[定义为既往诊断或HbA≥6.5%]<7.0%与≥7.0%），并进一步按糖尿病病程（<10年与≥10年）分层。
在调整分析中，与无糖尿病且HbA<5.7%的参与者相比，糖尿病前期参与者以及糖尿病且HbA<7.0%的参与者脑容量或血管病变无显著差异（均P>0.05），但糖尿病且HbA≥7.0%的参与者全脑体积较小（β -0.20标准差，95%置信区间 -0.31，-0.09），脑局部区域体积较小（包括额叶、颞叶、枕叶和顶叶；深部灰质；阿尔茨海默病特征区域；以及海马体[均P<0.05]），白质高信号（WMH）负担增加（P = 0.016）。在糖尿病患者中，与HbA<7.0%的患者相比，HbA≥7.0%的患者全脑和局部区域体积较小，WMH负担增加（均P<0.05）。同样，糖尿病病程较长（≥10年）的参与者与糖尿病病程<10年的参与者相比，脑容量较小，腔隙负担较高（均P<0.05）。通过结构方程模型，我们未发现WMH介导糖尿病与较小脑容量之间关联的证据（均P>0.05）。
更严重的糖尿病（由更高的HbA和更长的病程定义）而非糖尿病前期或不太严重的糖尿病与较小的脑容量以及脑血管病变负担增加有关。未发现糖尿病与较小脑容量之间的关联由脑血管病变介导的证据，这表明可能有其他机制导致这些关联。
Zotero 插件