title: Effect of hypoglycemia on brain structure in people with type 2 diabetes: epidemiological analysis of the ACCORD-MIND MRI trial.
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.
  
  
  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.
authors.affiliation: University of Pennsylvania, Philadelphia, PA.
authors.forename: Zi
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Wake Forest University, Winston Salem, NC.
authors.forename: James
authors.initials: J
authors.lastname: Lovato
authors.affiliation: University of Pennsylvania, Philadelphia, PA.
authors.forename: Harsha
authors.initials: H
authors.lastname: Battapady
authors.affiliation: University of Pennsylvania, Philadelphia, PA.
authors.forename: Christos
authors.initials: C
authors.lastname: Davatzikos
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Hertzel C
authors.initials: HC
authors.lastname: Gerstein
authors.affiliation: Case Western Reserve University, Cleveland, OH.
authors.forename: Faramarz
authors.initials: F
authors.lastname: Ismail-Beigi
authors.affiliation: National Institute on Aging, Bethesda, MD.
authors.forename: Lenore J
authors.initials: LJ
authors.lastname: Launer
authors.affiliation: Hennepin County Medical Center, Minneapolis, MN.
authors.forename: Anne
authors.initials: A
authors.lastname: Murray
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Zubin
authors.initials: Z
authors.lastname: Punthakee
authors.affiliation: Columbia University, New York, NY.
authors.forename: Amilcar A
authors.initials: AA
authors.lastname: Tirado
authors.affiliation: Wake Forest University, Winston Salem, NC.
authors.forename: Jeff
authors.initials: J
authors.lastname: Williamson
authors.affiliation: University of Pennsylvania, Philadelphia, PA nick.bryan@uphs.upenn.edu.
authors.forename: R Nick
authors.initials: RN
authors.lastname: Bryan
authors.affiliation: Wake Forest University, Winston Salem, NC.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D001284:Atrophy / Q000139:chemically induced / Q000453:epidemiology / Q000473:pathology; D001786:Blood Glucose / Q000187:drug effects; D001921:Brain / Q000187:drug effects / Q000473:pathology* / Q000502:physiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology*; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory / Q000187:drug effects; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents