年轻第二型糖尿病患的脑部灰质较少


  【24drs.com】一篇新研究中,最近被诊断有第二型糖尿病的20名10-20岁患者,脑部灰质量显著比相同年龄、种族、性别的20名体瘦、非糖尿病对照组小。
  
  虽然该研究强度不足以发现神经认知差异,但它确实发现,第二型糖尿病孩童与青年有比较低的「Woodcock-Johnson字汇破解分数」—也就是说,当他们大声阅读无意义词汇时,他们的拼音技巧很糟糕。
  
  俄亥俄州辛辛那提儿童医院临床研究员Jacob M Redel医师,6月14日时在美国糖尿病协会(ADA)2016年科学研讨会的理事长演讲时段中发表这篇研究。他与研究伙伴在摘要中表示,这些结果是否可以解释之前观察到的不佳认知分数,还有待确认。
  
  明尼亚波里明尼苏达大学医学院Elizabeth R Seaquist医师表示,它意谓著糖尿病患的脑部确实有所变化—甚至在孩童与青少年就很早发生。他们显然需要和一组肥胖孩童比较,因为肥胖本身也会影响脑部,但是它再度告诉我们,糖尿病对脑部有不良影响。
  
  Seaquist医师表示,其它研究曾经探讨第一型糖尿病孩童的脑部发育,而这是首度探讨第二型[糖尿病]孩童。另外,脑部发育是一个缓慢、漫长的过程,可能会被很多东西改变。她指出,探讨[脑部发育]和随时间变化之认知间的关联越来越重要,一篇更大型的研究或许可以发现其它认知结果。
  
  Gainesville佛罗里达大学小儿科教授、美国糖尿病协会医学与科学会议共同主持人暨理事长Desmond Schatz医师在评论时呼应,这篇研究样本数少,因此要谨慎诠释这些研究结果。他建议,追踪研究也要探讨这些年轻糖尿病患者的父母与手足的灰质量。
  
  他表示,同时,这篇研究暗示糖尿病的初期表征与疾病的侵略本质,真的有一些令人不安的后果。Schatz医师总结表示,我当然认为我们需要监控这一点,因为如果有一种方法可以介入,这是绝对关键。
  
  根据Redel医师指出,之前的研究显示,与同侪者相比,第二型糖尿病年轻患者有比较糟糕的认知-功能测试分数,但是,对于这类患者的脑灰质总量和区域量,还没有全面性的评估。
  
  为了了解这一点,研究者纳入了20名诊断有第二型糖尿病的肥胖患者与相对应的健康对照组。
  
  研究对象平均年龄16.7岁,糖尿病患者的身体质量指数(BMI)大于对照组(37.5 vs 24.5),平均而言,糖尿病患在2.8年前被诊断糖尿病时的平均HbA1c为7.9%。
  
  MRI扫描发现,相较于对照组,第二型糖尿病年轻患者的灰质总量比较少(717 cm2 vs 656 cm2 ; P = .012),不过白质量和总脑容量相当。
  
  为了考量相同年龄、种族、性别的孩童与年轻人的不同脑容量,研究者计算校正灰质量(灰质量除以总量);糖尿病患者的这个测量也是依旧显著较低(P = .02)。
  
  脑灰质量较低可预测词汇破解分数较低(P = .043)。
  
  Redel医师表示,研究者计画进行一篇比较大型的追踪研究,纳入肥胖的非糖尿病对照组。
  
  资料来源:http://www.24drs.com/
  
  Native link:Less Brain Gray-Matter Volume in Youth With Type 2 Diabetes

Less Brain Gray-Matter Volume in Youth With Type 2 Diabetes

By Marlene Busko
Medscape Medical News

NEW ORLEANS — Twenty obese 10- to 20-year-olds with recently diagnosed type 2 diabetes had significantly smaller brain gray-matter volumes than 20 lean, nondiabetic controls of the same age, race, and gender, in a new study.

Although the study wasn't powered to detect neurocognitive differences, it did find that the children and youths with type 2 diabetes had lower Woodcock-Johnson word attack scores — that is, they had worse phonetic skills when reading nonsense words aloud.

Jacob M Redel, MD, a clinical fellow at Cincinnati Children's Hospital, Ohio, presented the study on June 14 at the President's Oral Session here at the American Diabetes Association (ADA) 2016 Scientific Sessions. "Whether these findings explain poorer cognitive scores observed previously remains to be determined," he and his group say in their abstract.

"It does imply that something happens to the brain in people with diabetes — very early in exposure and even in children," Elizabeth R Seaquist, MD, University of Minnesota School of Medicine, Minneapolis, told Medscape Medical News. "They clearly need to do a comparison with an obese group of children because obesity has its own effects on the brain, but it tells us again that diabetes isn't good for the brain."

Other studies have examined brain development in children with type 1 diabetes, "but this is really the first in type 2 children," Dr Seaquist said. Moreover, brain development is a slow, lengthy process that can be altered by many things. "Correlating [brain development] to cognitive changes over time is going to be important," and a larger study might shed more light on other measures of cognition, she added.

The sample was small, and therefore these interesting findings need to be interpreted with caution, Desmond Schatz, MD, session comoderator and president, medicine and science, of the American Diabetes Association, and professor of pediatrics, University of Florida, Gainesville, echoed, in a comment to Medscape Medical News. Follow-up study should also look at gray-matter volume in the parents and siblings of these young diabetic patients, he suggested.

In the meantime, this study hints at "some really disturbing consequences of early appearance of diabetes and the aggressive nature of the disease," he said. "I certainly think we need to monitor this because if there's a way to intervene it's absolutely critical," Dr Schatz summarized.

Type 2 Diabetes and Brain Development in Children

Previous studies have shown that compared with their peers, youth with type 2 diabetes have worse cognitive-function test scores, but there has not been a comprehensive assessment of total and regional brain gray-matter volume in this patient population, according to Dr Redel.

To investigate this, the researchers enrolled 20 obese patients with diagnosed type 2 diabetes and matched them with healthy controls.

The participants had a mean age of 16.7 years, and the diabetic patients had a higher mean body mass index (BMI) than the control patients (37.5 vs 24.5). On average, the patients with diabetes had a mean HbA1c of 7.9% when they were diagnosed with diabetes 2.8 years ago.

MRI scans revealed that, compared with controls, the youth with type 2 diabetes had less total gray-matter volume (717 cm2 vs 656 cm2 ; P = .012) but similar white-matter and total brain volumes.

To account for different brain sizes in children and youth of the same age, race, and sex, the researchers calculated "adjusted gray-matter volume" (gray-matter volume divided by total volume); this measure too ""was still significantly lower in the diabetic patients (P = .02).

Having a lower volume of brain gray matter predicted a lower word-attack score (P = .043).

The researchers plan to do a follow-up study in a larger group of subjects, with obese, nondiabetic control patients, said Dr Redel.

Dr Redel and colleagues have no relevant financial relationships. Dr Seaquist is a former president of the American Diabetes Association and has consulted for Sanofi, Medtronic, Locemia Solutions, and Novo Nordisk. She has been on speakers' bureaus for Locemia Solutions and Novo Nordisk and has received research grants from Eli Lilly and the National Institutes of Health. Dr Schatz has no relevant financial relationships.

    
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