年輕第二型糖尿病患的腦部灰質較少


  【24drs.com】一篇新研究中,最近被診斷有第二型糖尿病的20名10-20歲患者,腦部灰質量顯著比相同年齡、種族、性別的20名體瘦、非糖尿病對照組小。
  
  雖然該研究強度不足以發現神經認知差異,但它確實發現,第二型糖尿病孩童與青年有比較低的「Woodcock-Johnson字彙破解分數」—也就是說,當他們大聲閱讀無意義詞彙時,他們的拼音技巧很糟糕。
  
  俄亥俄州辛辛那提兒童醫院臨床研究員Jacob M Redel醫師,6月14日時在美國糖尿病協會(ADA)2016年科學研討會的理事長演講時段中發表這篇研究。他與研究夥伴在摘要中表示,這些結果是否可以解釋之前觀察到的不佳認知分數,還有待確認。
  
  明尼亞波里明尼蘇達大學醫學院Elizabeth R Seaquist醫師表示,它意謂著糖尿病患的腦部確實有所變化—甚至在孩童與青少年就很早發生。他們顯然需要和一組肥胖孩童比較,因為肥胖本身也會影響腦部,但是它再度告訴我們,糖尿病對腦部有不良影響。
  
  Seaquist醫師表示,其他研究曾經探討第一型糖尿病孩童的腦部發育,而這是首度探討第二型[糖尿病]孩童。另外,腦部發育是一個緩慢、漫長的過程,可能會被很多東西改變。她指出,探討[腦部發育]和隨時間變化之認知間的關聯越來越重要,一篇更大型的研究或許可以發現其他認知結果。
  
  Gainesville佛羅里達大學小兒科教授、美國糖尿病協會醫學與科學會議共同主持人暨理事長Desmond Schatz醫師在評論時呼應,這篇研究樣本數少,因此要謹慎詮釋這些研究結果。他建議,追蹤研究也要探討這些年輕糖尿病患者的父母與手足的灰質量。
  
  他表示,同時,這篇研究暗示糖尿病的初期表徵與疾病的侵略本質,真的有一些令人不安的後果。Schatz醫師總結表示,我當然認為我們需要監控這一點,因為如果有一種方法可以介入,這是絕對關鍵。
  
  根據Redel醫師指出,之前的研究顯示,與同儕者相比,第二型糖尿病年輕患者有比較糟糕的認知-功能測試分數,但是,對於這類患者的腦灰質總量和區域量,還沒有全面性的評估。
  
  為了瞭解這一點,研究者納入了20名診斷有第二型糖尿病的肥胖患者與相對應的健康對照組。
  
  研究對象平均年齡16.7歲,糖尿病患者的身體質量指數(BMI)大於對照組(37.5 vs 24.5),平均而言,糖尿病患在2.8年前被診斷糖尿病時的平均HbA1c為7.9%。
  
  MRI掃描發現,相較於對照組,第二型糖尿病年輕患者的灰質總量比較少(717 cm2 vs 656 cm2 ; P = .012),不過白質量和總腦容量相當。
  
  為了考量相同年齡、種族、性別的孩童與年輕人的不同腦容量,研究者計算校正灰質量(灰質量除以總量);糖尿病患者的這個測量也是依舊顯著較低(P = .02)。
  
  腦灰質量較低可預測詞彙破解分數較低(P = .043)。
  
  Redel醫師表示,研究者計畫進行一篇比較大型的追蹤研究,納入肥胖的非糖尿病對照組。
  
  資料來源: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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