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- Title
Brain Activation During Working Memory Is Altered in Patients With Type 1 Diabetes During Hypoglycemia.
- Authors
Bolo, Nicolas R.; Musen, Gail; Jacobson, Alan M.; Weinger, Katie; McCartney, Richard L.; Flores, Veronica; Renshaw, Perry F.; Simonson, Donald C.
- Abstract
OBJECTIVE--To investigate the effects of acute hypoglycemia on working memory and brain function in patients with type 1 diabetes. RESEARCH DESIGN AND METHODS--Using blood oxygen level--dependent (BOLD) functional magnetic resonance imaging during euglycemic (5.0 mmol/L) and hypoglycemic (2.8 mmol/L) hyperinsulinemic clamps, we compared brain activation response to a working-memory task (WMT) in type 1 diabetic subjects (n = 16) with that in age-matched nondiabetic control subjects (n = 16). Behavioral performance was assessed by percent correct responses. RESULTS--During euglycemia, the WMT activated the bilateral frontal and parietal cortices, insula, thalamus, and cerebellum in both groups. During hypoglycemia, activation decreased in both groups but remained 80% larger in type 1 diabetic versus control subjects (P < 0.05). In type 1 diabetic subjects, higher HbA1c was associated with lower activation in the right parahippocampal gyrus and amygdala (R² = 0.45, P < 0.002). Deactivation of the default-mode network (DMN) also was seen in both groups during euglycemia. However, during hypoglycemia, type 1 diabetic patients deactivated the DMN 70% less than control subjects (P < 0.05). Behavioral performance did not differ between glycemic conditions or groups. CONCLUSIONS--BOLD activation was increased and deactivation was decreased in type 1 diabetic versus control subjects during hypoglycemia. This higher level of brain activation required by type 1 diabetic subjects to attain the same level of cognitive performance as control subjects suggests reduced cerebral efficiency in type 1 diabetes.
- Subjects
HYPOGLYCEMIA; TREATMENT of diabetes; CARBOHYDRATE intolerance; DIAGNOSTIC imaging; PEOPLE with diabetes
- Publication
Diabetes, 2011, Vol 60, Issue 12, p3256
- ISSN
0012-1797
- Publication type
Article
- DOI
10.2337/db11-0506