Regional Brain Volume Differences Associated With Hyperglycemia and Severe Hypoglycemia in Youth With Type 1 Diabetes

  1. Dana C. Perantie, BS1,
  2. Jenny Wu, BA1,
  3. Jonathan M. Koller, BS1,
  4. Audrey Lim, BA1,
  5. Stacie L. Warren, BA2,
  6. Kevin J. Black, MD1345,
  7. Michelle Sadler, RN, BSN, CDE6,
  8. Neil H. White, MD, CDE67 and
  9. Tamara Hershey, PHD134
  1. 1Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
  2. 2Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
  3. 3Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
  4. 4Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
  5. 5Department of Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, Missouri
  6. 6St. Louis Children's Hospital, St. Louis, Missouri
  7. 7Department of Psychology, University of Illinois, Urbana-Champaign, Illinois
  1. Address correspondence and reprint requests to Tamara Hershey, PhD, Campus Box 8225, 4525 Scott Ave., Washington University School of Medicine, St. Louis, MO 63110. E-mail: 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 previously been 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 (MRIs) were acquired from youth with diabetes (n = 108) and healthy sibling control subjects (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. A1C values since diagnosis were obtained from medical records; median A1C was weighted by duration of disease. Voxel-based morphometry was used to determine the relationships of prior hypo- and hyperglycemia to regional grey and white matter volumes across the whole brain.

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

CONCLUSIONS—Qualitatively different relationships were found between hypo- 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.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 15 June 2007. DOI: 10.2337/dc07-0351.

    Additional information for this article can be found in an online appendix at http://dx.doi.org/10.2337/dc07-0351.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Accepted June 7, 2007.
    • Received February 19, 2007.
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  1. Published online before print June 15, 2007, doi: 10.2337/dc07-0351 Diabetes Care September 2007 vol. 30 no. 9 2331-2337
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