@article{f0b98660e5f04ef4bcf27e7c57c12279,
title = "Brain Structure Among Middle-aged and Older Adults With Long-standing Type 1 Diabetes in the DCCT/EDIC Study",
abstract = "OBJECTIVE: Individuals with type 1 diabetes mellitus (T1DM) are living to ages when neuropathological changes are increasingly evident. We hypothesized that middle-aged and older adults with long-standing T1DM will show abnormal brain structure in comparison with control subjects without diabetes.RESEARCH DESIGN AND METHODS: MRI was used to compare brain structure among 416 T1DM participants in the Epidemiology of Diabetes Interventions and Complications (EDIC) study with that of 99 demographically similar control subjects without diabetes at 26 U.S. and Canadian sites. Assessments included total brain (TBV) (primary outcome), gray matter (GMV), white matter (WMV), ventricle, and white matter hyperintensity (WMH) volumes and total white matter mean fractional anisotropy (FA). Biomedical assessments included HbA1c and lipid levels, blood pressure, and cognitive assessments of memory and psychomotor and mental efficiency (PME). Among EDIC participants, HbA1c, severe hypoglycemia history, and vascular complications were measured longitudinally.RESULTS: Mean age of EDIC participants and control subjects was 60 years. T1DM participants showed significantly smaller TBV (least squares mean ± SE 1,206 ± 1.7 vs. 1,229 ± 3.5 cm3, P < 0.0001), GMV, and WMV and greater ventricle and WMH volumes but no differences in total white matter mean FA versus control subjects. Structural MRI measures in T1DM were equivalent to those of control subjects who were 4-9 years older. Lower PME scores were associated with altered brain structure on all MRI measures in T1DM participants.CONCLUSIONS: Middle-aged and older adults with T1DM showed brain volume loss and increased vascular injury in comparison with control subjects without diabetes, equivalent to 4-9 years of brain aging.",
keywords = "Aged, Brain/pathology, Canada, Diabetes Complications/complications, Diabetes Mellitus, Type 1/complications, Glycated Hemoglobin A/analysis, Humans, Middle Aged, Risk Factors",
author = "Jacobson, {Alan M} and Braffett, {Barbara H} and Guray Erus and Ryan, {Christopher M} and Biessels, {Geert J} and Luchsinger, {Jos{\'e} A} and Ionut Bebu and Gubitosi-Klug, {Rose A} and Lisa Desiderio and Lorenzi, {Gayle M} and Trapani, {Victoria R} and Lachin, {John M} and Bryan, {R Nick} and Mohamad Habes and Nasrallah, {Ilya M}",
note = "Funding Information: Funding. The DCCT/EDIC has been supported by cooperative agreement grants (1982–1993, 2012–2017, 2017–2022) and contracts (1982–2012) with the Division of Diabetes Endocrinology and Metabolic Diseases of the NIDDK (current grant numbers U01 DK094176 and U01 DK094157) and by the National Eye Institute, the National Institute of Neurologic Disorders and Stroke, the General Clinical Research Centers program (1993–2007), and Clinical & Translational Science Center program (2006–present), Bethesda, MD. Additional support for this DCCT/EDIC collaborative study was provided by NIDDK grant DP3 DK114812. Industry contributors provided free or discounted supplies or equipment to support participants{\textquoteright} adherence to the study: Abbott Diabetes Care (Alameda, CA), Animas (Westchester, PA), Bayer Diabetes Care (North America Headquarters, Tarrytown, NY), Becton, Dickinson and Company (Franklin Lakes, NJ), Eli Lilly (Indianapolis, IN), Extend Nutrition (St. Louis, MO), Insulet (Bedford, MA), Lifescan (Milpitas, CA), Medtronic Diabetes (Minneapolis, MN), Nipro Diagnostics (Ft. Lauderdale, FL), Nova Diabetes Care (Billeri-ca, MA), OMRON (Shelton, CT), Perrigo Diabetes Care (Allegan, MI), Roche Diabetes Care (Indianapolis, IN), and Sanofi (Bridgewater, NJ). Industry contributors have had no role in the DCCT/EDIC study. Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. A.M.J., B.H.B., and I.M.N. wrote the manuscript. B.H.B. and I.B. conducted the statistical analyses. G.E., L.D., and I.M.N. performed MRI analysis and quality control. G.E., C.M.R., G.J.B., J.A.L., I.B., R.A.G.-K., G.M.L., L.D., V.R.T., J.M.L., R.N.B., and M.H. Publisher Copyright: {\textcopyright} 2022 by the American Diabetes Association.",
year = "2022",
month = aug,
day = "1",
doi = "10.2337/dc21-2438",
language = "English",
volume = "45",
pages = "1779--1787",
journal = "Diabetes Care",
issn = "0149-5992",
publisher = "American Diabetes Association Inc.",
number = "8",
}