Brain abnormalities demonstrated by magnetic resonance imaging in adult IDDM patients with and without a history of recurrent severe hypoglycemia

• Published in: Diabetes care Vol. 20; no. 6; pp. 1013 - 1018
• Main Authors: PERROS, P, DEARY, I. J, SELLAR, R. J, BEST, J. J. K, FRIER, B. M
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.06.1997
• Subjects: Adult; Aspartic Acid - analogs & derivatives; Aspartic Acid - metabolism; Associated diseases and complications; Atrophy; Biological and medical sciences; Blood Glucose - metabolism; Brain - pathology; Brain research; Cerebral Cortex - pathology; Choline - metabolism; Cognition; Cognitive ability; Cohort Studies; Creatine - metabolism; Diabetes; Diabetes Mellitus, Type 1 - metabolism; Diabetes Mellitus, Type 1 - pathology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Glucose; Humans; Hypertension; Hypoglycemia; Hypoglycemia - epidemiology; Hypoglycemia - metabolism; Hypoglycemia - pathology; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Medical sciences; Middle Aged; Patients; Research design; Spectrum analysis; Tomography; Endocrinopathy; Human; Immunopathology; Nervous system diseases; Relapse; Autoimmune disease; Exploration; Cognition; Hypoglycemia; Nuclear magnetic resonance imaging; Cerebral disorder; Pathology; Central nervous system disease; Insulin dependent diabetes; Medical imagery; Complication; Diagnosis
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.20.6.1013

Brain abnormalities demonstrated by magnetic resonance imaging in adult IDDM patients with and without a history of recurrent severe hypoglycemia. P Perros , I J Deary , R J Sellar , J J Best and B M Frier Department of Diabetes, Royal Infirmary of Edinburgh, U.K. Abstract OBJECTIVE: Previous studies of a cohort of 100 patients with IDDM have shown that a history of recurrent severe hypoglycemia is associated with a modest impairment of cognitive function. The aim of the present study was to determine whether IDDM patients with and without a history of severe hypoglycemia have lesions in the brain that are identifiable by magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) and to investigate the putative relationship of any structural brain abnormalities with cognitive function. RESEARCH DESIGN AND METHODS: MRI and MRS of the brain were performed in 22 patients from the original cohort. Eleven IDDM patients with no history of severe hypoglycemia (group A) were compared with 11 IDDM patients who had a history of five or more episodes of severe hypoglycemia (group B). RESULTS: Nine patients (41%) had abnormal scans. Two types of abnormalities were observed: high-intensity rounded lesions, > 3 mm in diameters, distributed in the periventricular white matter (leukoaraiosis) in four patients; and cortical atrophy in five patients. Five patients in group B had cortical atrophy, whereas no patient in group A demonstrated this feature (P < 0.05). MRS of the frontal and parietal lobes showed no differences in the N-acetyl aspartate/creatine or N-acetyl aspartate/choline ratios between groups A and B. Patients with cortical atrophy showed a nonsignificant trend toward reduced performance on Rapid Visual Information Processing. CONCLUSIONS: Brain abnormalities demonstrated by MRI are common in patients with IDDM of long duration and are suggestive of premature aging of the brain. IDDM per se may be an important pathogenic factor, but a significant association was observed between a history of recurrent severe hypoglycemia and cortical atrophy, which may be related to the modest impairment of cognitive function that has been reported previously.