Type 2 diabetes

Two risk factors highlighted for dementia in T2D


The presence of left ventricular hypertrophy (LVH) is a potential biomarker for cerebral atrophy in patients with type 2 diabetes, the Australasian Diabetes Congress (ADC) 2021 has been told.

Dr Sheila Patel, from the vascular neurodegeneration research lab at the Florey Institute, presented preliminary results from the Diabetes and Dementia (D2) study.

The study enrolled 150 men and women with a mean age of 65 years and a median duration of diabetes of 15 years. Mean HbAc was 7.7% and participants had no prior history of neurological or psychiatric disease.

The study found LVH, determined by transthoracic echocardiography, was present in 27% of participants.

Those with LVH were significantly older, more likely to be female, have less than 12 years of education and a higher BMI. However there was no difference in diabetes duration, HbA1c or 24 hr systolic and diastolic blood pressures based on the presence or absence of LVH.

Hypertension was significantly higher in people with LVH; with almost all people with LVH also having hypertension. Dyslipidaemia and a history of MI were also more common in participants with LVH.

Dr Patel said the medication histories were similar in both groups with only beta blockers more commonly used in the LVH group.

High resolution 3T MRI showed that participants with LVH had significantly more atrophy of cortical thickness and the cerebral cortex compared to those without LVH at baseline.

“The differences in the cortical thickness and cerebral cortex remain significant after adjustment for covariates such as age, BMI, gender and education,” she said.

Those participants with LVH also had more atrophy in subcortical structures such as the putamen and the cerebellar cortex.

However those differences were no longer significant when adjusted for age, BMI, gender, education and total cranial volume.

Dr Patel said the findings suggest type 2 diabetes contributes to accelerated structural brain ageing and brain atrophy which manifests as cerebral atrophy.

“Both LVH and hypertension appear conflated as risk factors for brain atrophy,” she said.

While the presence of LVH may represent a risk factor for brain atrophy and subsequent cognitive impairment, it was not yet known if LVH contributes to dementia in type 2 diabetes.

Speaking to the limbic after her presentation, Dr Patel said that LVH had the advantage of being an easy to perform, single measurement.

A two-year follow-up of participants is underway and should report early next year.

“What’s nice about LVH is that it represents lifelong exposure to a person’s vascular risk factors.”

She said neurologist Professor Amy Brodtmann was conducting trials on exercise as an intervention to improve cognitive decline following stroke.

“Down the line this is a potential intervention for diabetes before patients have significant change in their brain…it could help delay the onset of poor cognitive function later in life,” Dr Patel said.

She said in her presentation it was known that older adults with type 2 diabetes have at least twice the risk of cognitive impairment or dementia compared to those without diabetes.

There was little evidence that treatment of diabetes was associated with reduced dementia risk.

 

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