Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA.
Diabetes Metab Res Rev. 2020 May;36(4):e3261. doi: 10.1002/dmrr.3261. Epub 2019 Dec 19.
Type 2 diabetes mellitus has been linked to structural brain abnormalities, but evidence of the association among prediabetes and structural brain abnormalities has not been systematically evaluated. Comprehensive searching strategies and relevant studies were systematically retrieved from PubMed, Embase, Medline and web of science. Twelve articles were included overall. Stratified analyses and regression analyses were performed. A total of 104 468 individuals were included. The risk of infarct was associated with continuous glycosylated haemoglobin (HbA ) [adjusted odds ratio (OR) 1.19 (95% confidence interval [CI]: 1.05-1.34)], or prediabetes [adjusted OR 1.13 (95% CI: 1.00-1.27)]. The corresponding ORs associated with white matter hyperintensities were 1.08 (95%CI: 1.04-1.13) for prediabetes, and 1.10 (95%CI: 1.08-1.12) for HbA . The association was significant between the decreased risk of brain volume with continuous HbA (the combined OR 0.92, 95% CI: 0.87-0.98). Grey matter volume and white matter volume were inversely associated with prediabetes [weighted mean deviation (WMD), -9.65 (95%CI: -15.25 to -4.04) vs WMD, -9.25 (95%CI: -15.03 to -3.47)]. There were no significant association among cerebral microbleeds, hippocampal volume, continuous total brain volume, and prediabetes. Our findings demonstrated that (a) both prediabetes and continuous HbA were significantly associated with increasing risk of infarct or white matter hyperintensities; (b) continuous HbA was associated with a decreased risk of brain volume; (c) prediabetes was inversely associated with grey matter volume and white matter volume. To confirm these findings, further studies on early diabetes onset and structural brain abnormalities are needed.
2 型糖尿病与结构性脑异常有关，但尚未系统评估前驱糖尿病与结构性脑异常之间的关联。从 PubMed、Embase、Medline 和 web of science 系统地检索了全面的搜索策略和相关研究。共纳入 12 篇文章。进行了分层分析和回归分析。共纳入 104468 人。梗死的风险与连续糖化血红蛋白（HbA ）相关[校正比值比（OR）1.19（95%置信区间[CI]：1.05-1.34）]或前驱糖尿病[校正 OR 1.13（95%CI：1.00-1.27）]。与脑白质高信号相关的相应 OR 为前驱糖尿病 1.08（95%CI：1.04-1.13），HbA 为 1.10（95%CI：1.08-1.12）。HbA 连续降低与脑体积降低之间存在显著相关性（合并 OR 0.92，95%CI：0.87-0.98）。灰质体积和白质体积与前驱糖尿病呈负相关[加权平均差异（WMD），-9.65（95%CI：-15.25 至-4.04）与 WMD，-9.25（95%CI：-15.03 至-3.47）]。脑微出血、海马体积、连续全脑体积与前驱糖尿病之间无显著相关性。我们的研究结果表明：（a）前驱糖尿病和连续 HbA 均与梗死或脑白质高信号的风险增加显著相关；（b）连续 HbA 与脑体积减少风险降低相关；（c）前驱糖尿病与灰质体积和白质体积呈负相关。为了证实这些发现，需要进一步研究早期糖尿病发病和结构性脑异常。
