title: Brain metabolic alterations in patients with type 1 diabetes-hyperglycemia-induced injury.
abstract: Microangiopathic end-organ injury is common in type 1 diabetes. However, the pathophysiology of diabetic encephalopathy is poorly understood. The authors studied 10 normotensive patients with type 1 diabetes with retinopathy, autonomic neuropathy, but without nephropathy, and 10 healthy subjects. Proton magnetic resonance spectroscopy was performed at 1.5 T in the frontal cortex, thalamus, and posterior frontal white matter. There was no change in N-acetyl-containing compounds (NA), but choline-containing compounds (Cho) were increased in the white matter and in the thalamus; myo-inositol was increased in the white matter, glucose excess was found in all brain, and water intensity was increased in the cortical voxel in the patients. Calculated lifetime glycemic exposure correlated inversely with Cho and NA in white matter and with Cho in thalamus. Concentrations of soluble intercellular adhesion molecules and vascular cell adhesion molecules were increased in the patients. In conclusion, in patients with type 1 diabetes, the increase in adhesion molecules and an association between altered brain metabolites and glycemic exposure suggest the presence of a vascularly mediated, progressive metabolic disturbance in the brain.
authors.affiliation: Department of Endocrinology and Diabetes, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland.
authors.forename: Sari
authors.initials: S
authors.lastname: Mäkimattila
authors.forename: Kirsi
authors.initials: K
authors.lastname: Malmberg-Cèder
authors.forename: Anna-Maija
authors.initials: AM
authors.lastname: Häkkinen
authors.forename: Kim
authors.initials: K
authors.lastname: Vuori
authors.forename: Oili
authors.initials: O
authors.lastname: Salonen
authors.forename: Paula
authors.initials: P
authors.lastname: Summanen
authors.forename: Hannele
authors.initials: H
authors.lastname: Yki-Järvinen
authors.forename: Markku
authors.initials: M
authors.lastname: Kaste
authors.forename: Sami
authors.initials: S
authors.lastname: Heikkinen
authors.forename: Nina
authors.initials: N
authors.lastname: Lundbom
authors.forename: Risto O
authors.initials: RO
authors.lastname: Roine
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000209:etiology* / Q000378:metabolism* / Q000473:pathology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000378:metabolism; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male