Prefrontal cortex brain damage and glycemic control in patients with type 2 diabetes

• Published in: Journal of diabetes Vol. 12; no. 6; pp. 465 - 473
• Main Authors: Choi, Sarah E., Roy, Bhaswati, Freeby, Matthew, Mullur, Rashmi, Woo, Mary A., Kumar, Rajesh
• Format: Journal Article
• Language: English
• Published: Melbourne Wiley Publishing Asia Pty Ltd 01.06.2020; John Wiley & Sons, Inc
• Subjects: Blood Glucose - analysis; Body mass index; Brain damage; brain injury; cognition; Cognition & reasoning; Cognition - physiology; Diabetes; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - diagnostic imaging; Diabetes Mellitus, Type 2 - drug therapy; Disease management; Female; Glucose; Glucose monitoring; Glycated Hemoglobin; HbA1c; Hemoglobin; Humans; Hypoglycemic Agents - therapeutic use; Magnetic Resonance Imaging; Male; Middle Aged; Neuropsychological Tests; prefrontal cortex; Prefrontal Cortex - diagnostic imaging; 前额叶皮质; 磁共振成像; 脑损伤; 认知; 认知; brain injury; magnetic resonance imaging; cognition; 磁共振成像; prefrontal cortex; 脑损伤; HbA1c; 前额叶皮质
• ISSN: 1753-0393; 1753-0407; 1753-0407
• DOI: 10.1111/1753-0407.13019

Background This study examined brain tissue integrity in sites that controls cognition (prefrontal cortices; PFC) and its relationships to glycemic outcomes in adults with type 2 diabetes mellitus (T2DM). Methods We examined 28 T2DM patients (median age 57.1 years; median body mass index [BMI] 30.6 kg/m2;11 males) and 47 healthy controls (median age 55.0 years; median BMI 25.8 kg/m2; 29 males) for cognition (Montreal Cognitive Assessment [MoCA]), glycemic control (hemoglobin A1c [HbA1c]), and PFC tissue status via brain magnetic resonance imaging (MRI). High‐resolution T1‐weighted images were collected using a 3.0‐Tesla MRI scanner, and PFC tissue changes (tissue density) were examined with voxel‐based morphometry procedures. Results Reduced PFC density values were observed in T2DM patients compared to controls (left, 0.41 ± 0.02 mm3/voxel vs 0.44 ± 0.02 mm3/voxel, P < 0.001; right, 0.41 ± 0.03 mm3/voxel vs 0.45 ± 0.02 mm3/voxel, P < 0.001). PFC density values were positively correlated with cognition; left PFC region (r = 0.53, P = 0.005) and right PFC region (r = 0.56, P = 0.003), with age and sex as covariates. Significant negative correlations were found between PFC densities and HbA1c values; left PFC region (r = −0.39, P = 0.049) and right PFC region (r = −0.48, P = 0.01), with age and sex as covariates. Conclusions T2DM patients showed PFC brain tissue damage, which is associated with cognitive deficits and poor glycemic control. Further research is needed to identify causal relationships between HbA1c, cognition, and brain changes in T2DM and to evaluate the impact of interventions to prevent brain tissue injury or neuroregeneration in this high‐risk patient population, to eventually preserve or enhance cognition and improve glucose outcomes. 摘要 背景 本研究检测了成人2型糖尿病(T2DM)患者控制认知部位(前额叶皮质; PFC)的脑组织完整性及其与血糖的关系。 方法 对28例T2DM患者(中位年龄57.1岁; 中位体重指数(BMI)30.6 kg/m2; 男性11例)和47例健康对照者(中位年龄55.0岁; 中位BMI 25.8 kg/m2; 男性29例)进行认知(蒙特利尔认知评估[MoCA])、血糖控制(血红蛋白A1c[HbA1c])和PFC组织状态的脑磁共振成像(MRI)检查。使用3.0‐Tesla MRI扫描仪采集高分辨率T1加权图像, 并用基于体素的形态计量学方法检查PFC组织的变化(组织密度)。 结果 T2DM组PFC密度较对照组降低(左侧: 0.41 ± 0.02 mm3/voxel vs 0.44 ± 0.02 mm3/voxel,P< 0.001; 右侧:0.41 ± 0.03 mm3/voxel vs 0.45 ± 0.02 mm3/voxel,P< 0.001))。以年龄、性别为协变量, 左侧PFC区(r=0.53 P=0.005)和右侧PFC区(r=0.56 P=0.003)与认知呈正相关。以年龄、性别为协变量, PFC密度与HbA1c值、左侧PFC区(r=−0.39, P=0.049)和右侧PFC区(r=−0.4 8, P=0.0 1)呈显著负相关。 结论 T2DM患者存在PFC脑组织损害, 与认知功能障碍和血糖控制不良有关。需要进一步研究确定T2DM中HbA1c、认知和脑变化之间的因果关系, 并评估干预措施的影响, 以防止这一高危患者群体的脑组织损伤或影响神经再生, 最终保护或增强认知并改善血糖结果。 Highlights T2DM patients have prefrontal cortices changes over non‐T2DM healthy individuals. Prefrontal cortices tissue changes are associated with cognitive deficits in T2DM patients. Prefrontal cortices damage is associated with poor glycemic control in T2DM.