R. Nick Bryan MD, PhD, Presenter: Nothing to Disclose

Michael E. Miller PhD, Abstract Co-Author: Nothing to Disclose

Lenore J. Launer, Abstract Co-Author: Nothing to Disclose

Jeff Williamson MD, Abstract Co-Author: Nothing to Disclose

James Lovato, Abstract Co-Author: Nothing to Disclose

Christos Davatzikos, Abstract Co-Author: Nothing to Disclose

Harsha Battapady MS, Abstract Co-Author: Nothing to Disclose

Zi Zhang MD, Abstract Co-Author: Nothing to Disclose

People with type 2 diabetes are at risk of white matter abnormalities. However, the effect of hypoglycemia on white matter is unknown. Our aim is to assess whether symptomatic severe hypoglycemia accelerates the increase of abnormal white matter (AWM) volume on brain MRI in treated type 2 diabetic patients.

This study included type 2 diabetic patients with brain MRI from the Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes trial (ACCORD-MIND) in North America. Symptomatic severe hypoglycemia was defined as either blood glucose<2.8 mmol/l or symptoms that resolved with treatments and that required either the assistance of another person or medical assistance. Brain MRI was performed at baseline and at 40 months. The standardized MRI scan protocol was run on 1.5 T scanners and included 3D SPGR T1, 2D axial FSE FLAIR, and PD/T2 weighted sequences. AWM volume was calculated using an automated multispectral computer algorithm.

Of the 503 patients with successful baseline and 40-month brain MRI (mean age 62.5 years), 28 patients had at least 1 episode of symptomatic severe hypoglycemia during the 40-month follow-up. The baseline AWM volume between patients without and with hypoglycemia showed no significant difference (1.99±3.62cm3 vs. 2.55±3.50cm3, p=.26). However, compared to patients without any episode, those with symptomatic severe hypoglycemia had a significant increase in AWM volume from baseline to 40 months (1.44±2.75cm3 vs. 2.53±3.06cm3, p=.01).

Our study suggests that symptomatic severe hypoglycemia accentuates pathological changes in white matter in treated type 2 diabetic patients, in addition to the better-known ischemic and inflammatory effects of type 2 diabetes on white matter.

Symptomatic severe hypoglycemia related to diabetic treatment may increase chronic white matter lesions in type 2 diabetic patients.

Bryan, R, Miller, M, Launer, L, Williamson, J, Lovato, J, Davatzikos, C, Battapady, H, Zhang, Z, Effect of Symptomatic Severe Hypoglycemia on White Matter Structure in Patients with Type 2 Diabetes.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12043568.html