Increased Burden of Cerebral Small Vessel Disease in Patients With Type 2 Diabetes and Retinopathy.
We sought to examine the presence and severity of brain small vessel disease (SVD) in patients with type 2 diabetes and diabetic retinopathy (DR) compared with those without DR.



We evaluated 312 patients with type 2 diabetes without previous cardiovascular disease (men 51%; mean age 57 years; age range 40-75 years); 153 patients (49%) had DR. MRI was performed to evaluate the presence and severity (age-related white matter changes scale) of white matter lesions (WMLs) and lacunes, and transcranial Doppler ultrasound was used to measure the Gosling pulsatility index (PI) of the middle cerebral artery (MCA).



The prevalence of lesions of cerebral SVD (WML and/or lacunes) was higher in patients with DR (40.2% vs. 30.1% without DR, P = 0.04). Age (P < 0.01) and systolic blood pressure (P = 0.02) were associated with the presence of SVD. The severity of SVD was associated with age and the presence of DR (P < 0.01 and P = 0.01, respectively). Patients with DR showed a higher MCA PI compared with those without DR (P < 0.01). Age, systolic and diastolic blood pressure, and retinopathy and its severity were associated with an increased MCA PI (P < 0.01 for all variables). A positive correlation was found between MCA PI values and the presence and severity of SVD (P < 0.01 for both variables).



Patients with type 2 diabetes who have DR have an increased burden of cerebral SVD compared with those without DR. Our findings suggest that the brain is a target organ for microangiopathy, similar to other classic target organs, like the retina.
Department of Neurology, University Hospital Arnau de Vilanova, Lleida, Spain.
Jordi
J
Sanahuja
Department of Endocrinology and Nutrition, Germans Trias i Pujol Health Science Research Institute and University Hospital, Badalona, Spain CIBERDEM, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
Núria
N
Alonso
Institut de Diagnòstic per la Imatge, University Hospital Arnau de Vilanova, Lleida, Spain.
Javier
J
Diez
Institut de Recerca Biomedica de Lleida, University of Lleida, Lleida, Spain.
Emilio
E
Ortega
Department of Endocrinology & Nutrition, Institut d'Investigacions Biomediques August Pi Suñer, Centro de Investigación Biomédica en Red de la Obesidad y la Nutrición, Hospital Clinic, Barcelona, Spain.
Esther
E
Rubinat
Department of Ophthalmology, University Hospital Arnau de Vilanova, Lleida, Spain.
Alícia
A
Traveset
Department of Endocrinology & Nutrition, Institut d'Investigacions Biomediques August Pi Suñer, Centro de Investigación Biomédica en Red de la Obesidad y la Nutrición, Hospital Clinic, Barcelona, Spain.
Núria
N
Alcubierre
Unitat de Detecció i Tractament de Malalties Aterotrombòtiques, University Hospital Arnau de Vilanova, Lleida, Spain.
Àngels
À
Betriu
Department of Endocrinology and Nutrition, Germans Trias i Pujol Health Science Research Institute and University Hospital, Badalona, Spain.
Esmeralda
E
Castelblanco
Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, Lleida, Spain.
Marta
M
Hernández
Department of Neurology, University Hospital Arnau de Vilanova, Lleida, Spain.
Francisco
F
Purroy
Unitat de Detecció i Tractament de Malalties Aterotrombòtiques, University Hospital Arnau de Vilanova, Lleida, Spain.
Maria Vittoria
MV
Arcidiacono
Department of Ophthalmology, University Hospital Arnau de Vilanova, Lleida, Spain.
Carmen
C
Jurjo
Department of Endocrinology & Nutrition, Institut d'Investigacions Biomediques August Pi Suñer, Centro de Investigación Biomédica en Red de la Obesidad y la Nutrición, Hospital Clinic, Barcelona, Spain Unitat de Detecció i Tractament de Malalties Aterotrombòtiques, University Hospital Arnau de Vilanova, Lleida, Spain Department of Nephrology, University Hospital Arnau de Vilanova, Lleida, Spain.
Elvira
E
Fernández
Department of Endocrinology and Nutrition, Germans Trias i Pujol Health Science Research Institute and University Hospital, Badalona, Spain CIBERDEM, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
Manuel
M
Puig-Domingo
Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; and Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
Per-Henrik
PH
Groop
Department of Endocrinology and Nutrition, Germans Trias i Pujol Health Science Research Institute and University Hospital, Badalona, Spain CIBERDEM, Instituto de Salud Carlos III (ISCIII), Madrid, Spain didacmauricio@gmail.com.
Dídac
D
Mauricio
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001921:Brain / Q000000981:diagnostic imaging*; D002318:Cardiovascular Diseases; D059345:Cerebral Small Vessel Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D002560:Cerebrovascular Circulation; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D003930:Diabetic Retinopathy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D011673:Pulsatile Flow; D012720:Severity of Illness Index; D017585:Ultrasonography, Doppler, Transcranial