Does the brain shrink in diabetes?

Diabetes makes the brain shrink

08/12/2014

The health consequences of type 2 diabetes are mainly possible impairments of the blood vessels in the form of arteriosclerosis and damage to the nervous system (diabetic neuropathies) known. However, a recent US study concludes that type 2 diabetes can also shrink the brain, reports the German Diabetes Association (DDG). So far, the effects of metabolic disease on the brain have apparently been underestimated.

In the course of type 2 diabetes, a reduction of the brain is noted in those affected, which points to an accelerated aging of the mind, the statement of the DDG. „The longer the patients suffered from type 2 diabetes and the higher the blood sugar level, the smaller their brains“, reports the professional society. Significant cause is not - as previously assumed - the calcification of the blood vessels in the brain, but „atrophy is more likely to be due to direct damage to the brain cells, as occurs in degenerative diseases such as Alzheimer's disease“, explains Professor Andreas Fritsche from the University Hospital Tübingen in the DDG press release.

Vascular calcification in the brain
More than six million people in Germany suffer from diabetes, much of it from type 2 diabetes. This is characterized by a relative lack of the hormone insulin, which means that the blood sugar level can no longer be lowered sufficiently. „In addition to blood sugar, obesity and blood pressure are often increased in overweight type 2 diabetic patients“, reports the DDG on. The interaction of these factors promotes the development of vascular calcification, which can lead to circulatory disorders in the brain, which in turn are accompanied by corresponding impairments of the brain substance. „Diabetes can therefore limit the performance of the brain in the long term“, explained DDG President Erhard Siegel. However, the impairments have so far been attributed mainly to small punctate brain infarcts, „which occur in the brain with age - even in non-diabetic patients - and become visible on MRI images“, reports the DDG. Here we speak of a so-called vascular dementia.

Duration of the disease and level of blood sugar crucial
However, according to the experts, this vascular dementia does not explain the observed breakdown of brain matter in the current US study. „However, the study of more than 600 patients who participated in the diabetes study clinical trial points in a different direction“, reports the DDG. So the team around Nick Bryan from the Perelman School of Medicine in Philadelphia compared „the size of the brain with the duration of diabetes and the level of blood glucose in the fasting state“ It has been found that with the duration of the disease and the level of blood sugar, the brain increasingly shrinks. Especially in the gray matter, where the nerve cells are located, the differences were recognizable. Less clear was the effect on the white matter in which the nerve fibers are located.

Brain of diabetics ages early
Overall, subjects have lost an average of 4.28 out of 463.9 cubic centimeters of their gray matter over a ten-year period, corresponding to accelerated aging of the brain, reports the DDG. „Her brain was two years older than her non-diabetic patient of the same age after that time“, emphasized the DDG spokesman Professor Dirk Müller-Wieland. This loss of cerebral substance can not be explained by early calcification of the blood vessels, especially as the study could not detect an increase in cerebral infarcts. Rather, the atrophy is evidence of direct damage to the brain cells. In particular, too high blood sugar show here a significant negative impact. While staying „It is unclear whether strict control of blood sugar has a beneficial effect on the development of the cerebral condition, as MRI examinations were performed only at the beginning of the study.“ But it is clear that participants with better blood glucose levels in the initial examination showed the least loss of nerve cells, reports the DDG. „Per 50 units less in blood glucose, the volume of gray matter increased by 2.65 cubic centimeters“, so the message of the professional society. Professor Müller-Wieland added that it did „certainly does not depend solely on the control of blood sugar.“ Here, normalization of blood pressure and blood lipid levels are also part of the treatment of type 2 diabetes. „Healthy nutrition and physical activity are influential factors“, emphasized DDG President Erhard Siegel. (Fp)