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Meta-analyses of structural regional cerebral effects in type 1 and type 2 diabetes

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Abstract

Diabetes is associated with macrovascular and microvascular complications and is a major risk factor for neurological and psychiatric disorders, such as dementia and depression. Type 1 diabetes (T1DM) and type 2 diabetes (T2DM) have distinct etiologies and pathophysiological effects while sharing a common endpoint of persistent hyperglycemia. Neuroimaging studies in T1DM have revealed reductions in numerous regions, including the parahippocampal and occipital regions, while in T2DM there have been numerous reports of hippocampal atrophy. This meta-analysis aimed to identify consistent regional abnormalities in cerebral structures in T1DM and T2DM respectively, and also to examine the impact of potential confounds, including age, depression and vascular risk factors. Neuroimaging studies of both voxel-based morphometry (VBM) data and volumetric data were included. Ten T1DM studies (n = 613 patients) and 23 T2DM studies (n = 1364 patients) fulfilled inclusion criteria. The T1DM meta-analysis revealed reduced bilateral thalamus grey matter density in adults. The T2DM meta-analysis revealed reduced global brain volume and regional atrophy in the hippocampi, basal ganglia, and orbitofrontal and occipital lobes. Moreover, hippocampal atrophy in T2DM was not modified by hypertension, although there were more marked reductions in younger patients relative to healthy controls. In conclusion, T1DM and T2DM demonstrated distinct cerebral effects with generalised and specific target areas of grey matter reduction. Thalamic atrophy in T1DM may be a substrate of associated cognitive deficits. In T2DM, global cerebral atrophy may reflect atherosclerotic factors, while hippocampal atrophy was an independent effect providing a potential common neuropathological etiology for the comorbidity of T2DM with dementia and depression.

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Conflict of interest

Calum D. Moulton, Sergi G. Costafreda, Paul Horton, Khalida Ismail, and Cynthia H. Y. Fu declare that they have no conflicts of interest.

Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, and the applicable revisions at the time of the investigation. Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Department of Psychological Medicine, Institute of Psychiatry, King’s College London, London, UK

    Calum D. Moulton & Khalida Ismail

  2. Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK

    Sergi G. Costafreda

  3. Department of Old Age Psychiatry, Institute of Psychiatry, King’s College London, London, UK

    Paul Horton

  4. School of Psychology, University of East London, London, UK

    Cynthia H. Y. Fu

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  1. Calum D. Moulton
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Supplementary Fig. 1

Forest plot of hippocampal volume in T1DM studies. Non-significant reduction found in T1DM compared to controls (DOCX 54 kb)

Supplementary Fig. 2

Forest plots of total brain volume. Non-significant reduction found in T1DM compared to controls (left) and significant reduction in T2DM compared to controls (right) (DOCX 108 kb)

Supplementary Fig. 3

Forest plots of total grey matter volume. Non-significant reduction found in T1DM compared to controls (left) and significant reduction in T2DM compared to controls (right) (DOCX 114 kb)

Supplementary Fig. 4

Forest plot of total frontal volume. Non-significant reduction found in T2DM compared to controls (DOCX 65 kb)

Supplementary Table 1

Potential confounding variables for T1DM studies (DOCX 15 kb)

Supplementary Table 2

Potential confounding variables for T2DM studies (DOCX 17 kb)

Supplementary Table 3

Volumetric meta-analysis results in T1DM (DOCX 13 kb)

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Moulton, C.D., Costafreda, S.G., Horton, P. et al. Meta-analyses of structural regional cerebral effects in type 1 and type 2 diabetes. Brain Imaging and Behavior 9, 651–662 (2015). https://doi.org/10.1007/s11682-014-9348-2

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