PMID- 25267796
OWN - NLM
STAT- MEDLINE
DCOM- 20150616
LR  - 20211021
IS  - 1935-5548 (Electronic)
IS  - 0149-5992 (Print)
IS  - 0149-5992 (Linking)
VI  - 37
IP  - 12
DP  - 2014 Dec
TI  - Effect of hypoglycemia on brain structure in people with type 2 diabetes: 
      epidemiological analysis of the ACCORD-MIND MRI trial.
PG  - 3279-85
LID - 10.2337/dc14-0973 [doi]
AB  - OBJECTIVE: The effect of hypoglycemia related to treatment of type 2 diabetes 
      mellitus (T2DM) on brain structure remains unclear. We aimed to assess whether 
      symptomatic severe hypoglycemia is associated with brain atrophy and/or white 
      matter abnormalities. RESEARCH DESIGN AND METHODS: We included T2DM participants 
      with brain MRI from the Action to Control Cardiovascular Risk in Diabetes-Memory 
      in Diabetes (ACCORD-MIND) trial. Symptomatic severe hypoglycemia was defined as 
      blood glucose <2.8 mmol/L or symptoms resolved with treatments that required the 
      assistance of another person or medical assistance (hypoglycemia requiring 
      assistance [HA]). Standardized brain MRI was performed at baseline and at 40 
      months. Total brain volume (TBV) and abnormal white matter (AWM) volume were 
      calculated using an automated computer algorithm. Brain MRI scans of hypoglycemic 
      participants were also reviewed for local disease. RESULTS: Of the 503 T2DM 
      participants (mean age, 62 years) with successful baseline and 40-month brain 
      MRI, 28 had at least one HA episode during the 40-month follow-up. Compared with 
      participants without HA, those with HA had marginally significant less atrophy 
      (less decrease in TBV) from baseline to 40 months (-9.55 [95% CI -15.21, -3.90] 
      vs. -15.38 [95% CI -16.64, -14.12], P = 0.051), and no significant increase of 
      AWM volume (2.06 [95% CI 1.71, 2.49] vs. 1.84 [95% CI 1.76, 1.91], P = 0.247). In 
      addition, no unexpected local signal changes or volume loss were seen on 
      hypoglycemic participants' brain MRI scans. CONCLUSIONS: Our study suggests that 
      hypoglycemia related to T2DM treatment may not accentuate brain pathology, 
      specifically brain atrophy or white matter abnormalities.
CI  - (c) 2014 by the American Diabetes Association. Readers may use this article as long 
      as the work is properly cited, the use is educational and not for profit, and the 
      work is not altered.
FAU - Zhang, Zi
AU  - Zhang Z
AD  - University of Pennsylvania, Philadelphia, PA.
FAU - Lovato, James
AU  - Lovato J
AD  - Wake Forest University, Winston Salem, NC.
FAU - Battapady, Harsha
AU  - Battapady H
AD  - University of Pennsylvania, Philadelphia, PA.
FAU - Davatzikos, Christos
AU  - Davatzikos C
AD  - University of Pennsylvania, Philadelphia, PA.
FAU - Gerstein, Hertzel C
AU  - Gerstein HC
AD  - McMaster University, Hamilton, Ontario, Canada.
FAU - Ismail-Beigi, Faramarz
AU  - Ismail-Beigi F
AD  - Case Western Reserve University, Cleveland, OH.
FAU - Launer, Lenore J
AU  - Launer LJ
AD  - National Institute on Aging, Bethesda, MD.
FAU - Murray, Anne
AU  - Murray A
AD  - Hennepin County Medical Center, Minneapolis, MN.
FAU - Punthakee, Zubin
AU  - Punthakee Z
AD  - McMaster University, Hamilton, Ontario, Canada.
FAU - Tirado, Amilcar A
AU  - Tirado AA
AD  - Columbia University, New York, NY.
FAU - Williamson, Jeff
AU  - Williamson J
AD  - Wake Forest University, Winston Salem, NC.
FAU - Bryan, R Nick
AU  - Bryan RN
AD  - University of Pennsylvania, Philadelphia, PA nick.bryan@uphs.upenn.edu.
FAU - Miller, Michael E
AU  - Miller ME
AD  - Wake Forest University, Winston Salem, NC.
LA  - eng
SI  - ClinicalTrials.gov/NCT00182910
GR  - N01HC95184/HL/NHLBI NIH HHS/United States
GR  - N01-HC-95180/HC/NHLBI NIH HHS/United States
GR  - AG-0002/AG/NIA NIH HHS/United States
GR  - N01-HC-95184/HC/NHLBI NIH HHS/United States
GR  - N01HC95181/HL/NHLBI NIH HHS/United States
GR  - N01-HC-95182/HC/NHLBI NIH HHS/United States
GR  - R01 EB009234/EB/NIBIB NIH HHS/United States
GR  - N01-HC-95178/HC/NHLBI NIH HHS/United States
GR  - N01HC95182/HL/NHLBI NIH HHS/United States
GR  - N01-HC-95181/HC/NHLBI NIH HHS/United States
GR  - N01HC95178/HL/NHLBI NIH HHS/United States
GR  - N01HC95183/HL/NHLBI NIH HHS/United States
GR  - N01HC95179/HL/NHLBI NIH HHS/United States
GR  - N01-HC-95183/HC/NHLBI NIH HHS/United States
GR  - ImNIH/Intramural NIH HHS/United States
GR  - N01HC95180/HL/NHLBI NIH HHS/United States
GR  - N01-HC-95179/HC/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, N.I.H., Intramural
DEP - 20140929
PL  - United States
TA  - Diabetes Care
JT  - Diabetes care
JID - 7805975
RN  - 0 (Blood Glucose)
RN  - 0 (Hypoglycemic Agents)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Atrophy/chemically induced/epidemiology/pathology
MH  - Blood Glucose/drug effects
MH  - Brain/drug effects/*pathology/physiology
MH  - Cardiovascular Diseases/epidemiology/prevention & control
MH  - Diabetes Mellitus, Type 2/*drug therapy/epidemiology/pathology
MH  - Female
MH  - Humans
MH  - Hypoglycemia/*chemically induced/epidemiology/*pathology
MH  - Hypoglycemic Agents/*adverse effects
MH  - *Magnetic Resonance Imaging
MH  - Male
MH  - Memory/drug effects
MH  - Middle Aged
MH  - Risk Factors
PMC - PMC4237972
EDAT- 2014/10/01 06:00
MHDA- 2015/06/17 06:00
PMCR- 2015/12/01
CRDT- 2014/10/01 06:00
PHST- 2014/10/01 06:00 [entrez]
PHST- 2014/10/01 06:00 [pubmed]
PHST- 2015/06/17 06:00 [medline]
PHST- 2015/12/01 00:00 [pmc-release]
AID - dc14-0973 [pii]
AID - 0973 [pii]
AID - 10.2337/dc14-0973 [doi]
PST - ppublish
SO  - Diabetes Care. 2014 Dec;37(12):3279-85. doi: 10.2337/dc14-0973. Epub 2014 Sep 29.