Clinical and MRI features about two types of silent cerebral small-vessel disease in type-2 diabetes mellitus: a retrospective cross-sectional study in a tertiary hospital

Abstract

Background: The present study aimed to evaluate the frequency of silent cerebral small-vessel disease, especially lacunes and white matter hyperintensities, in patients with or without the impaired glucose tolerance (IGT) and type-2 diabetes mellitus, and to characterize the diabetes-correlated factors related to silent cerebral small-vessel disease.Methods: This is a retrospective cross-sectional study. Totally 698 patients were included in this study, from January 2014 to December 2019, among which 270 patients were included in the diabetes mellitus group, 106 patients were included in the IGT group, and 322 patients were included in the Control group.All patients underwent magnetic resonance imaging to investigate the silent cerebral small-vessel disease: the lacunes and the white matter hyperintensities. All the baseline information and diabetes-related factors, such as glycated hemoglobin level, insulin usage, etc., were collected. Then correlation analysis and regression analysis were used to explore the correlation between diabetes with related risk factors and silent cerebral small-vessel disease.Results: Lacunes and white matter hyperintensities were more common in the diabetes mellitus group than in the IGT group and the Control group, with an occurrence of lacunes of 83.3% vs. 70.8% vs. 70.4% (P=0.003), respectively, and an occurrence of white matter hyperintensities of 41.1% vs. 24.5% vs. 31.1% (P=0.003), respectively. The occurrence of lacunes was correlated with the duration of diabetes mellitus {odds ratio [OR] =1.483, 95% confidence interval (CI): 1.082, 2.031, P=0.009} and the age (OR =1.141, 95% CI:1.102, 1.180, P<0.001), while white matter hyperintensities were independently correlated only with the age (OR =1.124, 95% CI: 1.094, 1.155, P<0.001).Conclusions: Lacunes and white matter hyperintensities, are more common in the diabetes mellitus patients than in the IGT patients or in the other patients. The occurrence of lacunes was correlated with the duration of diabetes mellitus and the age, while the occurrence of white matter hyperintensities was independently correlated with the age.

Cross‐sectional association of continuous glucose monitoring‐derived metrics with cerebral small vessel disease in older adults with type 2 diabetes

“…To date, the results of studies investigating the relationship between HbA1c levels and cerebral SVD have been inconsistent. [9][10][11][12][13][14][15] In this study, although higher HbA1c levels showed higher odds of higher cerebral SVD scores, this relationship was not significant.…”

“…A few previous studies showed that a higher glycated haemoglobin (HbA1c) level is associated with a higher burden of WMH, 9 cerebral microbleeds, 10 and incident lacunes, 11 whereas many studies did not show significant associations. [12][13][14][15] Some studies have reported that metrics of glycaemic variability, which cannot be gleaned from the evaluation of HbA1c alone, were associated with a higher volume of WMH. 16,17 Continuous glucose monitoring (CGM) has become more common in managing people with diabetes in recent years.…”

“…The relationship between glucose levels and cerebral SVD is also still not fully clear in people with type 2 diabetes. A few previous studies showed that a higher glycated haemoglobin (HbA1c) level is associated with a higher burden of WMH, 9 cerebral microbleeds, 10 and incident lacunes, 11 whereas many studies did not show significant associations 12–15 . Some studies have reported that metrics of glycaemic variability, which cannot be gleaned from the evaluation of HbA1c alone, were associated with a higher volume of WMH 16,17 …”

SGLT1 and SGLT2 inhibition, circulating metabolites, and cerebral small vessel disease: a mediation Mendelian Randomization study

“…Type-2 diabetes mellitus (T2DM) is a well-established risk factor for cerebrovascular diseases, such as ischemic stroke [ 3 , 4 ]. Recent studies have suggested that T2DM is one of the major risk factor for microangiopathy and that patients with diabetes mellitus are more likely to suffer from CSVD [ 5 , 6 ]. A comprehensive review revealed a substantial correlation between an elevated risk of small subcortical infarcts or white matter hyperintensity (WMH) and prediabetes and increased glycated hemoglobin A1c (HbA1c) level [ 7 ].…”