Brain Structure Among Middle-aged and Older Adults With Long-standing Type 1 Diabetes in the DCCT/EDIC Study

Authors

Alan M. Jacobson, NYU Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola.
Barbara H. Braffett, The Biostatistics Center, The George Washington University, Rockville, MD.
Guray Erus, Department of Radiology, University of Pennsylvania, Philadelphia, PA.
Christopher M. Ryan, University of Pittsburgh, Pittsburgh, PA.
Geert J. Biessels, Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Netherlands.
José A. Luchsinger, Columbia University Irving Medical Center, New York, NY.
Ionut Bebu, The Biostatistics Center, The George Washington University, Rockville, MD.
Rose A. Gubitosi-Klug, Case Western Reserve University School of Medicine, Rainbow Babies & Children's Hospital, Cleveland, OH.
Lisa Desiderio, Department of Radiology, University of Pennsylvania, Philadelphia, PA.
Gayle M. Lorenzi, University of California San Diego, La Jolla, CA.
Victoria R. Trapani, Department of Radiology, University of Pennsylvania, Philadelphia, PA.
John M. Lachin, Department of Radiology, University of Pennsylvania, Philadelphia, PA.
R Nick Bryan, The University of Texas at Austin, Austin, TX.
Mohamad Habes, Neuroimage Analytics Laboratory and Biggs Institute Neuroimaging Core, Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX.
Ilya M. Nasrallah, Department of Radiology, University of Pennsylvania, Philadelphia, PA.

Document Type

Journal Article

Publication Date

6-14-2022

Journal

Diabetes care

DOI

10.2337/dc21-2438

Abstract

OBJECTIVE: Individuals with type 1 diabetes mellitus (T1DM) are living to ages when neuropathological changes are increasingly evident. We hypothesized that middle-aged and older adults with long-standing T1DM will show abnormal brain structure in comparison with control subjects without diabetes. RESEARCH DESIGN AND METHODS: MRI was used to compare brain structure among 416 T1DM participants in the Epidemiology of Diabetes Interventions and Complications (EDIC) study with that of 99 demographically similar control subjects without diabetes at 26 U.S. and Canadian sites. Assessments included total brain (TBV) (primary outcome), gray matter (GMV), white matter (WMV), ventricle, and white matter hyperintensity (WMH) volumes and total white matter mean fractional anisotropy (FA). Biomedical assessments included HbA1c and lipid levels, blood pressure, and cognitive assessments of memory and psychomotor and mental efficiency (PME). Among EDIC participants, HbA1c, severe hypoglycemia history, and vascular complications were measured longitudinally. RESULTS: Mean age of EDIC participants and control subjects was 60 years. T1DM participants showed significantly smaller TBV (least squares mean ± SE 1,206 ± 1.7 vs. 1,229 ± 3.5 cm3, P < 0.0001), GMV, and WMV and greater ventricle and WMH volumes but no differences in total white matter mean FA versus control subjects. Structural MRI measures in T1DM were equivalent to those of control subjects who were 4-9 years older. Lower PME scores were associated with altered brain structure on all MRI measures in T1DM participants. CONCLUSIONS: Middle-aged and older adults with T1DM showed brain volume loss and increased vascular injury in comparison with control subjects without diabetes, equivalent to 4-9 years of brain aging.

APA Citation

Jacobson, Alan M.; Braffett, Barbara H.; Erus, Guray; Ryan, Christopher M.; Biessels, Geert J.; Luchsinger, José A.; Bebu, Ionut; Gubitosi-Klug, Rose A.; Desiderio, Lisa; Lorenzi, Gayle M.; Trapani, Victoria R.; Lachin, John M.; Bryan, R Nick; Habes, Mohamad; and Nasrallah, Ilya M., "Brain Structure Among Middle-aged and Older Adults With Long-standing Type 1 Diabetes in the DCCT/EDIC Study" (2022). GW Authored Works. Paper 1120.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1120

Department

Epidemiology