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Publish date: September 14, 2016
Key clinical point: People with prediabetes and type 2 diabetes have more white matter hyperintensities and lower white matter volume than do those with healthy glucose metabolism.
Major finding: Healthy subjects carried about 0.75 mL of white matter hyperintensities, while prediabetic subjects carried about 1.25 mL, and those with diabetes, about 2.0 mL.
Data source: The subset of the Maastricht Study comprised 2,251 subjects.
Disclosures: Dr. van Agtmaal had no financial disclosures.
MUNICH – Brain changes suggestive of cerebral microvascular dysfunction are already apparent in patients with prediabetes.
The changes – increased white matter hyperintensities and decreased white matter volume – are even more pronounced in subjects with type 2 diabetes, Marnix van Agtmaal, MD, said at the annual meeting of the European Association for the Study of Diabetes. Patients with frank diabetes also showed an increase in intracranial cerebrospinal fluid – a correlate of the decrease in brain volume, said Dr. van Agtmaal of Maastricht (the Netherlands) University Medical Center.
The changes are probably caused by diabetes-related endothelial dysfunction, he said.
“The brain is highly dependent on properly functioning microcirculation. This is critical, since the brain has high energy demand and no energy reserve. In prediabetes and type 2 diabetes, microvascular endothelial dysfunction occurs. This leads to cerebral hypoperfusion, which in turns causes chronic ischemia. This contributes to small vessel disease leading to brain atrophy and, eventually, cognitive decline and dementia.”
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