Abstract
Type 2 diabetes mellitus is associated with neurodegeneration and cerebrovascular disease. However, the precise mechanism underlying the effects of glucose management on brain abnormalities is not fully understood. The differential impacts of glucose alteration on brain changes in patients with and without cognitive impairment are also unclear. This cross-sectional study included 57 older type 2 diabetes patients with a diagnosis of Alzheimer’s disease (AD) or normal cognition (NC). We examined the effects of hypoglycemia, postprandial hyperglycemia and glucose fluctuations on regional white matter hyperintensity (WMH) and brain atrophy among these patients. In a multiple regression analysis, postprandial hyperglycemia was independently associated with frontal WMH in the AD patients. In addition, postprandial hyperglycemia was significantly associated with brain atrophy, regardless of the presence of cognitive decline. Altogether, our findings indicate that postprandial hyperglycemia is associated with WMH in AD patients but not NC patients, which suggests that AD patients are more susceptible to postprandial hyperglycemia associated with WMH.
Highlights
Increasing evidence shows that type 2 diabetes mellitus is associated with neurodegeneration and cerebral vascular disease (Arnold et al, 2018)
The following patients were included in the study: (a) outpatients with type 2 diabetes who were treated with antidiabetic agents, (b) patients aged 65 years or older, (c) patients living at their houses, (d) patients with a Mini-Mental State Examination (MMSE) score ≥ 10 for Alzheimer’s disease (AD) and (e) patients with family members or caregivers who assist with selfmonitored blood glucose (SMBG)
Our findings indicate that postprandial hyperglycemia is associated with White matter hyperintensity (WMH) in only AD patients, which suggests that AD patients are more susceptible to postprandial hyperglycemia associated with WMH
Summary
Increasing evidence shows that type 2 diabetes mellitus is associated with neurodegeneration and cerebral vascular disease (Arnold et al, 2018). The presence of diabetes is a significant risk factor for the incidence of Alzheimer’s disease (AD) and vascular dementia (VaD) in the elderly (Ohara et al, 2011). The mechanism underlying its relationship with these phenomena is not fully understood, clinical features such as cognitive deficits, large- and small-vessel disease, cerebral. Postprandial Hyperglycemia and Brain Abnormalities atrophy, hypometabolism, and impaired insulin activation in the brain, overlap between type 2 diabetes and AD (Arnold et al, 2018). White matter hyperintensity (WMH), one of the cerebral small vessel diseases, presents as hyperintense areas on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images and as isointense or hypointense areas on T1-weighted images on magnetic resonance (MR) imaging. Preventive strategies capable of delaying WMH progression should be identified to successfully manage older people with diabetes
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