Structural Brain Differences in T1D and IAH

Nicole Stantonyonge, Frederic Sampedro, Jorge Méndez, Saül Martínez-Horta, Ana Chico, Beatriz Gómez-Anson
The Journal of Clinical Endocrinology & Metabolism, Volume 106, Issue 2, February 2021, Pages 450–458
https://doi.org/10.1210/clinem/dgaa832

Abstract

Context

Type 1 diabetes (T1D) is associated with an increased risk of cognitive decline, where severe hypoglycemia (SH) and impaired awareness of hypoglycemia (IAH) may play a role. While there is evidence of a possible association between IAH and brain damage, the potential brain changes remain poorly characterized by magnetic resonance imaging (MRI).

Objective

To investigate whether there are structural brain differences in a group of T1D patients with IAH compared with normal awareness of hypoglycemia (NAH).

Design

General practice, population-based, cross-sectional study (July 2018 to July 2019).

Setting

Endocrinology Department, Hospital Santa Creu i Sant Pau.

Participants

A total of 40 T1D patients (20 each with IAH and NAH) matched for age, sex, T1D duration, and education level.

Main Outcome Measures

Using different neuroimaging techniques, we compared whole-brain gray matter (GM) and white matter (WM) differences. We used voxel-based morphometry and cortical surface area analysis methods to assess GM differences, and fractional anisotropy (FA) to assess WM differences.

Results

Compared with patients with T1D-NAH, patients with T1D-IAH had reduced GM volumes and cortical surface areas, especially in frontal and parietal regions (P < 0.05 corrected), and also showed reduced FA values in major WM tracts. The observed MRI differences correlated with both SH frequency and IAH severity.

Conclusions

MRI for patients with T1D show that IAH is associated with brain changes involving both GM and WM. Further research is needed to elucidate whether the observed differences are a consequence of increased SH episode frequency and increased IAH severity.

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