Adults with type 1 diabetes are more likely to develop cerebral small-vessel disease, and cerebral micro-bleeds, in particular, than those without diabetes, according to findings published in Diabetes Care.
“Type 1 diabetes is associated with a fivefold increased risk of stroke, with cerebral small-vessel disease (SVD) as the most common etiology,” Per-Henrik Groop, MD, DMSc, FRCPE, professor of nephrology at Helsinki University Central Hospital in Finland, and colleagues wrote.
“Cerebral SVD in type 1 diabetes, however, remains scarcely investigated and is challenging to study in vivo per se owing to the size of affected vasculature.”
Groop and colleagues analyzed data from 191 healthy younger adults with type 1 diabetes diagnosed before age 40 years (age range, 18 to 50 years; mean age, 40 years; 53% women) who presented consecutively at Helsinki University Hospital; data from 30 adults without diabetes (mean age, 38.4 years; 57% women) were used for comparison. All participants were enrolled in the Finnish Diabetic Nephropathy Study and underwent MRI to asses incidence of cerebral small-vessel disease.
Among the type 1 diabetes cohort, 67 participants (35%) were diagnosed with cerebral small-vessel disease compared with three participants (10%) in the control group. In the diabetes group with cerebral small-vessel disease, 45 (24%) had cerebral micro-bleeds and 44 (23%) had white matter hyperintensities.
The presence of albuminuria (P = .021), use of antihypertensive medication (P = .033) and higher systolic blood pressure (P = .009) were observed more often in participants with cerebral micro-bleeds; systolic BP was the only independently associated factor (OR = 1.03 for each 1-mm Hg increase; 95% CI, 1.00-1.05). Age was the only independently associated factor for white matter hyperintensities (OR = 1.11 for each 1-year age increase; 95% CI, 1.04-1.19).
“Our results indicate that cerebral SVD starts early in type 1 diabetes but is not explained solely by diabetes-related vascular risk factors or the generalized microvascular disease that takes place in diabetes,” the researchers wrote.
“Cerebral micro-bleeds were mainly observed in the lobar brain regions, which has been associated with cerebral amyloid angiopathy, a condition generally affecting the elderly, whereas cerebral micro-bleed] in the deeper parts associate with hypertensive vasculopathy.”
Clinical and MRI Features of Cerebral Small-Vessel Disease in Type 1 Diabetes
Lena M. Thorn, Sara Shams, Daniel Gordin, Ron Liebkind, Carol Forsblom, Paula Summanen, Stefanie Hägg-Holmberg, Turgut Tatlisumak, Oili Salonen, Jukka Putaala, Juha Martola and Per-Henrik Groop, on behalf of the FinnDiane Study Group
Diabetes Care 2018 Dec; dc181302.
OBJECTIVE To assess the prevalence of cerebral small-vessel disease (SVD) in subjects with type 1 diabetes compared with healthy control subjects and to characterize the diabetes-related factors associated with SVD.
RESEARCH DESIGN AND METHODS This substudy was cross-sectional in design and included 191 participants with type 1 diabetes and median age 40.0 years (interquartile range 33.0–45.1) and 30 healthy age- and sex-matched control subjects. All participants underwent clinical investigation and brain MRIs, assessed for cerebral SVD.
RESULTS Cerebral SVD was more common in participants with type 1 diabetes than in healthy control subjects: any marker 35 vs. 10% (P = 0.005),
cerebral microbleeds (CMBs) 24 vs. 3.3% (P= 0.008),
white matter hyperintensities 17 vs. 6.7% (P = 0.182), and
lacunes 2.1 vs. 0% (P = 1.000).
Presence of CMBs was independently associated with systolic blood pressure (odds ratio 1.03 [95% confidence interval 1.00–1.05], P = 0.035).
CONCLUSIONS Cerebral SVD, CMBs in particular, is more common in young people with type 1 diabetes compared with healthy control subjects.
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