(11-10-14) Effect of Hypoglycemia on Brain Structure in People With Type 2 Diabetes

: Epidemiological Analysis of the ACCORD-MIND MRI Trial.

Zhang Z1, Lovato J2, Battapady H1, Davatzikos C1, Gerstein HC3, Ismail-Beigi
F4, Launer LJ5, Murray A6, Punthakee Z3, Tirado AA7, Williamson J2, Bryan RN8,
Miller ME2.
Author information

Abstract
OBJECTIVE:
The effect of hypoglycemia related to treatment of type 2 diabetes mellitus
(T2DM) on brain structure remains unclear. We aimed to assess whether
symptomatic severe hypoglycemia is associated with brain atrophy and/or white
matter abnormalities.
RESEARCH DESIGN AND METHODS:
We included T2DM participants with brain MRI from the Action to Control
Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) trial.
Symptomatic severe hypoglycemia was defined as blood glucose <2.8 mmol/L or
symptoms resolved with treatments that required the assistance of another
person or medical assistance (hypoglycemia requiring assistance [HA]).
Standardized brain MRI was performed at baseline and at 40 months. Total brain
volume (TBV) and abnormal white matter (AWM) volume were calculated using an
automated computer algorithm. Brain MRI scans of hypoglycemic participants were
also reviewed for local disease.
RESULTS:
Of the 503 T2DM participants (mean age, 62 years) with successful baseline and
40-month brain MRI, 28 had at least one HA episode during the 40-month follow-
up. Compared with participants without HA, those with HA had marginally
significant less atrophy (less decrease in TBV) from baseline to 40 months
(-9.55 [95% CI -15.21, -3.90] vs. -15.38 [95% CI -16.64, -14.12], P = 0.051),
and no significant increase of AWM volume (2.06 [95% CI 1.71, 2.49] vs. 1.84
[95% CI 1.76, 1.91], P = 0.247). In addition, no unexpected local signal
changes or volume loss were seen on hypoglycemic participants' brain MRI scans.
CONCLUSIONS:
Our study suggests that hypoglycemia related to T2DM treatment may not
accentuate brain pathology, specifically brain atrophy or white matter
abnormalities.

Source: Diabetes Care. 2014 Sep 29. pii: DC_140973. [Epub ahead of print]

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