Department of Radiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Open Innovation Institute, Kyoto University, Kyoto, Japan.
Eur Radiol. 2023 Aug;33(8):5378-5384. doi: 10.1007/s00330-023-09509-z. Epub 2023 Mar 9.
Diabetes frequently results in cognitive impairment, but it is less clear if brain health is adversely affected during the prediabetic stage. Our aim is to identify possible changes in brain volume as measured by magnetic resonance imaging (MRI) in a large elderly population stratified according to level of "dysglycemia."
This is a cross-sectional study of 2144 participants (median age 69 years, 60.9% female) who underwent 3-T brain MRI. Participants were divided into 4 dysglycemia groups based on HbA1c levels (%): normal glucose metabolism (NGM) (< 5.7%), prediabetes (5.7 to < 6.5%), undiagnosed diabetes (6.5% or higher), and known diabetes (defined by self-report).
Of the 2144 participants, 982 had NGM, 845 prediabetes, 61 undiagnosed diabetes, and 256 known diabetes. After adjustment for age, sex, education, body weight, cognitive status, smoking, drinking, and disease history, total gray matter volume was significantly lower among participants with prediabetes (0.41% lower, standardized β = - 0.0021 [95% CI - 0.0039, - 0.00039], p = 0.016), undiagnosed diabetes (1.4% lower, standardized β = - 0.0069 [95% CI - 0.012, - 0.002], p = 0.005), and known diabetes (1.1% lower, standardized β = - 0.0055 [95% CI - 0.0081, - 0.0029], p < 0.001) compared to the NGM group. After adjustment, total white matter volume and hippocampal volume did not differ significantly between the NGM group and either the prediabetes group or the diabetes group.
Sustained hyperglycemia may have deleterious effects on gray matter integrity even prior to the onset of clinical diabetes.
• Sustained hyperglycemia has deleterious effects on gray matter integrity even prior to the onset of clinical diabetes.
糖尿病常导致认知障碍，但在糖尿病前期阶段，大脑健康是否受到不利影响尚不清楚。我们的目的是在按“糖代谢异常”水平分层的大型老年人群中，通过磁共振成像（MRI）来确定脑容量可能发生的变化。
这是一项横断面研究，共纳入 2144 名参与者（中位年龄 69 岁，60.9%为女性），他们接受了 3-T 脑部 MRI 检查。根据 HbA1c 水平（%），参与者被分为 4 组糖代谢异常人群：正常葡萄糖代谢（NGM）（<5.7%）、糖尿病前期（5.7%~<6.5%）、未确诊的糖尿病（6.5%或更高）和已知的糖尿病（自我报告）。
在 2144 名参与者中，982 名有 NGM，845 名有糖尿病前期，61 名有未确诊的糖尿病，256 名有已知的糖尿病。在调整年龄、性别、教育程度、体重、认知状态、吸烟、饮酒和病史后，与 NGM 组相比，糖尿病前期组（低 0.41%，标准化β=-0.0021[95%CI-0.0039，-0.00039]，p=0.016）、未确诊的糖尿病组（低 1.4%，标准化β=-0.0069[95%CI-0.012，-0.002]，p=0.005）和已知的糖尿病组（低 1.1%，标准化β=-0.0055[95%CI-0.0081，-0.0029]，p<0.001）的总灰质体积明显降低。经调整后，与 NGM 组相比，糖尿病前期组和糖尿病组的总白质体积和海马体积差异无统计学意义。
持续的高血糖可能对灰质完整性造成有害影响，甚至在临床糖尿病发病之前。
•持续的高血糖对灰质完整性有有害影响，甚至在临床糖尿病发病之前。
