Prefrontal Cortical Deficits in Type 1 Diabetes Mellitus

Abstract

Context Neural substrates that may be responsible for the high prevalence of depression in type 1 diabetes mellitus (T1DM) have not yet been elucidated. Objective To investigate neuroanatomic correlates of depression in T1DM. Design Case-control study using high-resolution brain magnetic resonance images. Settings Joslin Diabetes Center and McLean Hospital, Massachusetts, and Seoul National University Hospital, South Korea. Participants A total of 125 patients with T1DM (44 subjects with ≥1 previous depressive episodes [T1DM-depression group] and 81 subjects who had never experienced depressive episodes [T1DM-only group]), 23 subjects without T1DM but with 1 or more previous depressive episodes (depression group), and 38 healthy subjects (control group). Main Outcome Measures Spatial distributions of cortical thickness for each diagnostic group were compared with the control group using a surface-based approach. Among patients with T1DM, associations between metabolic control measures and cortical thickness deficits were examined. Results Thickness reduction in the bilateral superior prefrontal cortical regions was observed in the T1DM-depression, T1DM-only, and depression groups relative to the control group at corrected P<.01. Conjunction analyses demonstrated that thickness reductions related to the influence of T1DM and those related to past depressive episode influence were observed primarily in the superior prefrontal cortical region. Long-term glycemic control levels were associated with superior prefrontal cortical deficits in patients with T1DM (β = −0.19, P = .02). Conclusions This study provides evidence that thickness reduction of prefrontal cortical regions in patients with T1DM, as modified by long-term glycemic control, could contribute to the increased risk for comorbid depression.

The Relationship of Mental Health & Family Functioning with Maintaining Optimal Glycaemic Control in Type 1 Diabetes

“…The hippocampus has been found to be extremely sensitive to changes in glucose levels, with fluctuations being associated with decreased hippocampal neurogenesis (Gispen and Biessels, 2000). It has been postulated that this is a possible mechanism to explain how emotional difficulties that are associated with sub-optimal glycaemic control, such as depression, arise (Lyoo, Yoon, Jacobson, et al, 2012). The findings in this study would be consistent with such an assertion.…”

“…Work in this field has repeatedly shown that sub-optimal glycaemic control is associated with depressive symptoms (Monaghan, Singh, Streisand, et al, 2010;Cameron and Northam, 2012), with a potential mechanism being the disturbance of hippocampal functioning (Boyle et al, 1994) and/or cortical architecture (Lyoo, Yoon, Jacobson, et al, 2012). In the current study, there was a clear increase of depressive symptoms among young people, and while this sample cannot be considered representative of all adolescents with type 1 diabetes, it is interesting that more boys were found to be struggling with significant symptoms of depression than girls, a reversal of the prevalence in the general population (Essau, Lewinsohn, Seeley, et al, 2010).…”

“…There is some suggestion of an association between type I diabetes in children and ADHD symptoms (Chen, Lee, Yeh, et al, 2013), and the changes in the prefrontal cortex associate with sub-optimal glycaemic control (Lyoo et al, 2012) (Cameron, Young and Wiebe, 2007). In the current study little correlation between the GHQ results and the young people's emotional and behavioural symptoms was found, although the mothers of girls did show a modest correlation between the girl being anxious and the mother reporting depressive symptoms.…”

Mental Disorders in Subjects with Diabetes: A Systematic Review

“…The study found that women with depressive symptoms had a 17% higher risk of developing diabetes and women who use antidepressants had a 25% higher risk of developing diabetes than those who had not depressive symptoms [35]. This study also found that women with diabetes had a 29% higher chance of depression and women use insulin had a 53% higher risk of depression compared with women patients without diabetes [35][36][37][38][39][40][41]. When insulin is not working well, high blood sugar levels build in the body and the consequence of that is comorbidity in several areas, eyes, heart and mental disorders.…”

Prefrontal Cortex Governs Normalcy and Psychiatric Illness: Neuroimaging Evidence

“…Diminished metabolic activity in prefrontal cortex has been shown in schizophrenia [14][15][16], depression [9,17], in depression associated with diabetes [18], depression associated with Parkinson's disease, depression associated with stroke, depression associated with Huntington's disease, bipolar disorder [19], addictive behavior [20], obsessivecompulsive disorder [21], chronic pain [22]. Reduced functional connectivity within cortical limbic loop has been shown in obsessive compulsive disorder [23,24] and depression [9,17,25].…”