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Regional brain volume differences associated with hyperglycemia and severe hypoglycemia in youth with type 1 diabetes.

¹Departments of Psychiatry, Washington University School of Medicine
²Departments of Neurology, Washington University School of Medicine
³Departments of Radiology, Washington University School of Medicine
⁴Departments of Pediatrics, Washington University School of Medicine
⁵Departments of Anatomy & Neurobiology, Washington University School of Medicine
⁶St. Louis Children's Hospital
⁷Department of Psychology, University of Illinois

tammy{at}wustl.edu

ABSTRACT

Objective:Despite interest in the effects of type 1 diabetes on the developing brain, structural brain volumes in youth with this disease have not been previously examined. This study is the first to quantify regional brain volume differences in a large sample of youth with diabetes.

Research Design and Methods:Magnetic resonance images (MRI) were acquired from youth with diabetes (n=108) and healthy sibling controls (HC; n=51) aged 7-17 years. History of severe hypoglycemia was assessed by parent interview and included seizure, loss of consciousness, or requiring assistance to treat. Hemoglobin A1c (HbA1c) values since diagnosis were obtained from medical records; median HbA1c was weighted by duration of disease. Voxel-based morphometry (SPM5) was used to determine the relationships of prior hypoglycemia and hyperglycemia to regional gray and white matter volumes across the whole brain.

Results:No significant differences were found between diabetic and HC groups in gray or white matter. However, within the diabetic group, a history of severe hypoglycemia was associated with smaller gray matter volume in the left superior temporal region. Greater exposure to hyperglycemia was associated with smaller gray matter volume in the right cuneus and precuneus, smaller white matter volume in a right posterior parietal region, and larger gray matter volume in a right prefrontal region.

Conclusions:Qualitatively different relationships were found between hypoglycemia and hyperglycemia and regional brain volumes in youth with type 1 diabetes. Future studies should investigate whether these differences relate to cognitive function and how these regions are affected by further exposure.

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