Department of General Medical, Shanxi Bethune Hospital Shanxi Academy of Medical Sciences, Taiyuan, China.
Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China.
Front Endocrinol (Lausanne). 2020 Dec 21;11:595962. doi: 10.3389/fendo.2020.595962. eCollection 2020.
White matter (WM) disease is recognized as an important cause of cognitive decline and dementia. White matter lesions (WMLs) appear as white matter hyperintensities (WMH) on T2-weighted magnetic resonance imaging (MRI) scans of the brain. Previous studies have shown that type 2 diabetes (T2DM) is associated with WMH. In this review, we reviewed the literature on the relationship between T2DM and WMH in PubMed and Cochrane over the past five years and explored the possible links among the presence of T2DM, the course or complications of diabetes, and WMH. We found that: (1) Both from a macro- and micro-scopic point of view, most studies support the relationship of a larger WMH and a decrease in the integrity of WMH in T2DM; (2) From the relationship between brain structural changes and cognition in T2DM, the poor performance in memory, attention, and executive function tests associated with abnormal brain structure is consistent; (3) Diabetic microangiopathy or peripheral neuropathy may be associated with WMH, suggesting that the brain may be a target organ for T2DM microangiopathy; (4) Laboratory markers such as insulin resistance and fasting insulin levels were significantly associated with WMH. High HbA1c and high glucose variability were associated with WMH but not glycemic control.
脑白质病变是认知功能下降和痴呆的重要原因。脑白质病变（WML）在脑 T2 加权磁共振成像（MRI）扫描中表现为脑白质高信号（WMH）。既往研究表明，2 型糖尿病（T2DM）与 WMH 相关。本综述对过去 5 年在 PubMed 和 Cochrane 中关于 T2DM 与 WMH 关系的文献进行了复习，探讨了 T2DM 的存在、糖尿病的病程或并发症与 WMH 之间可能存在的联系。结果显示：（1）从宏观和微观角度来看，大多数研究支持 T2DM 患者 WMH 体积增大和 WMH 完整性降低的关系；（2）从 T2DM 患者脑结构变化与认知的关系来看，与异常脑结构相关的记忆、注意力和执行功能测试表现较差的结果一致；（3）糖尿病微血管病变或周围神经病变可能与 WMH 相关，提示大脑可能是 T2DM 微血管病变的靶器官；（4）胰岛素抵抗和空腹胰岛素水平等实验室标志物与 WMH 显著相关。HbA1c 升高和血糖变异性升高与 WMH 相关，但与血糖控制无关。
