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Regional Brain Structure Alterations in Diabetes but Not Prediabetes
Liangqi Wang1,2,3,4, Huandong Lin3,5,6, Zehua Zhao7
1Department of Radiology, Shanghai Geriatric Medical Center, Shanghai 201104, China.
The Journal of Clinical Endocrinology and Metabolism
|April 30, 2025
Summary
Diabetes significantly alters brain structure and white matter, impacting cognition and motor function. These changes appear specific to diabetes, not prediabetes, highlighting the need for early intervention.
Area of Science:
- Neuroimaging
- Endocrinology
- Neurology
Background:
- Diabetes mellitus is known to affect brain structure, including gray matter volume (GMV) and white matter hyperintensities (WMH).
- The progression of regional GMV and tract-specific WMH during the prediabetes stage remains largely uncharacterized.
Purpose of the Study:
- To investigate and compare brain structural changes across three glycemic states: diabetes, prediabetes, and control.
- To examine the relationship between glycemic status, brain structural alterations, cognitive function, and motor performance.
Main Methods:
- Analysis of 512 participants (122 diabetes, 109 prediabetes, 281 controls) using structural T1-weighted and FLAIR MRI.
- Neuroimaging data were complemented by cognitive assessments (MoCA), grip strength, and gait speed measurements.
- Correlational analyses were performed to link brain changes with clinical and functional outcomes across glycemic groups.
Main Results:
- Substantial GMV reductions were observed in diabetic individuals, particularly in motor and coordination areas (cerebellum, precentral, postcentral gyri), correlating with lower cognitive scores, gait speed, and grip strength.
- Prediabetic individuals did not exhibit these significant brain structural changes or associated functional deficits.
- Diabetic brains showed a significantly higher WMH index across multiple tracts, with WMH severity positively correlating with glycemic levels.
Conclusions:
- Diabetes exerts a profound impact on cerebral architecture, leading to significant gray matter volume loss and white matter hyperintensities.
- Brain structural changes and associated functional impairments appear to be a consequence of established diabetes, rather than a gradual decline starting in prediabetes.
- Findings emphasize the critical importance of diabetes prevention and management to preserve brain health and highlight potential brain resilience in early metabolic dysregulation.
