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07-15-2022 | Dementia | News

Progressing prediabetes a ‘key turning point’ for white matter damage

Author: Eleanor McDermid


medwireNews: Researchers have identified localized white matter microstructural damage in people with prediabetes and widespread abnormalities in those with type 2 diabetes.

More specifically, the team found significant local changes on diffusion tensor imaging in people with prediabetes who had both impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), but not in those with just one of these glucose metabolism deficiencies.

“This finding suggested that impairment of [white matter] microstructure may occur slowly during the process of prediabetes to diabetes, with the stage of prediabetes with combined IFG/IGT being the key turning point,” write Yongjun Wang (Capital Medical University, Beijing, China) and co-researchers in eBioMedicine.

“Consequently, strategies to maintain normal glucose metabolism should begin early, prior to the stage of prediabetes with combined IFG/IGT, to protect the integrity of [white matter] microstructure.”

Compared with people who had normal glucose metabolism, those with IFG/IGT had significantly reduced fraction anisotropy, mainly in the bilateral anterior corona radiata (ACR) and right superior longitudinal fasciculus, the posterior corona radiata, and the anterior limb of internal capsule. There was also a significant increase in mean diffusivity in the right external capsule and superior corona radiata. These changes both indicated a reduction in white matter integrity.

People with diabetes had reduced integrity affecting “widespread” white matter tracts, with the greatest damage seen in the body of corpus callosum, the bilateral ACR and external capsule, the posterior thalamic radiation (PTR), and the right inferior fronto-occipital fasciculus.

The researchers note that damage to some of the affected areas, such as the PTR and the external capsule, is associated with various neurologic disorders and gait dysfunction.

After multivariable adjustment, higher fasting plasma glucose and glycated hemoglobin levels were significantly associated with lower fraction anisotropy values, both globally and in specific areas including the ACR and PTR. There were no associations between glucose measures and mean diffusivity, however.

For this study, Wang and team drew on data from the population-based prospective cohort PRECISE study, which included adults aged between 50 and 75 years at the baseline assessment between May 2017 and September 2019. There were 2218 participants with complete brain imaging and clinical data, including 1205 (54.3%) with prediabetes and 504 (22.7%) with diabetes. They were an average age of 61.3 years and 54.1% were women.

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group

EBioMedicine 2022; 82: 104144


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