OBJECTIVE Prediabetes and type 2 diabetes are associated with structural brain abnormalities, often observed in cognitive disorders. Besides visible lesions, (pre)diabetes might also be associated with alterations of the intrinsic organization of the white matter. In this population-based cohort study, the association of prediabetes and type 2 diabetes with white matter network organization was assessed. RESEARCH DESIGN AND METHODS In the Maastricht Study, a type 2 diabetes-enriched population-based cohort study (1,361 subjects with normal glucose metabolism, 348 with prediabetes, and 510 with type 2 diabetes assessed by oral glucose tolerance test; 52% men; aged 59 ± 8 years), 3 Tesla structural and diffusion MRI was performed. Whole-brain white matter tractography was used to assess the number of connections (node degree) between 94 brain regions and the topology (graph measures). Multivariable linear regression analyses were used to investigate the associations of glucose metabolism status with network measures. Associations were adjusted for age, sex, education, and cardiovascular risk factors. RESULTS Prediabetes and type 2 diabetes were associated with lower node degree after full adjustment (standardized [st]βPrediabetes = -0.055 [95% CI -0.172, 0.062], stβType2diabetes = -0.256 [-0.379, -0.133], P trend < 0.001). Prediabetes was associated with lower local efficiency (stβ = -0.084 [95% CI -0.159, -0.008], P = 0.033) and lower clustering coefficient (stβ = -0.097 [95% CI -0.189, -0.005], P = 0.049), whereas type 2 diabetes was not. Type 2 diabetes was associated with higher communicability (stβ = 0.148 [95% CI 0.042, 0.253], P = 0.008). CONCLUSIONS These findings indicate that prediabetes and type 2 diabetes are associated with fewer white matter connections and weaker organization of white matter networks. Type 2 diabetes was associated with higher communicability, which was not yet observed in prediabetes and may reflect the use of alternative white matter connections.

中文翻译：

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前驱糖尿病和2型糖尿病的白质连通性异常：马斯特里赫特研究。

目的前驱糖尿病和2型糖尿病与脑结构异常有关，通常在认知障碍中观察到。除可见病变外，（前）糖尿病也可能与白质内在组织的改变有关。在这项基于人群的队列研究中，评估了糖尿病前期和2型糖尿病与白质网络组织的关联。研究设计与方法在马斯特里赫特研究中，一项基于人群的2型糖尿病人群研究（通过口服糖耐量测试评估了1,361名糖代谢正常的受试者，348名糖尿病前期受试者和510名2型糖尿病受试者； 52％的男性；年龄较大） 59±8年），进行了3​​例Tesla结构和扩散MRI。全脑白质束描记术用于评估94个大脑区域和拓扑结构之间的连接数（节点度）（图形度量）。多变量线性回归分析用于研究葡萄糖代谢状态与网络测量之间的关系。根据年龄，性别，教育程度和心血管危险因素对协会进行了调整。结果完全调整后，前驱糖尿病和2型糖尿病与下节度相关（标准[st]β前驱糖尿病= -0.055 [95％CI -0.172，0.062]，stβ2型糖尿病= -0.256 [-0.379，-0.133]，P趋势<0.001 ）。糖尿病前期患者的局部效率较低（stβ= -0.084 [95％CI -0.159，-0.008]，P = 0.033）和聚类系数较低（stβ= -0.097 [95％CI -0.189，-0.005]，P = 0.049 ），而2型糖尿病则不是。2型糖尿病与较高的传染性相关（stβ= 0.148 [95％CI 0.042，0.253]，P = 0.008）。结论这些发现表明，前驱糖尿病和2型糖尿病与较少的白质联系和较弱的白质网络组织有关。2型糖尿病与较高的传染性相关，这在前驱糖尿病中尚未观察到，可能反映了替代性白质连接的使用。