Abstract
Context
Individuals with type 1 diabetes (T1DM) have alterations in brain activity which have been postulated to contribute to the adverse neurocognitive consequences of T1DM; however, the impact of T1DM and hypoglycemic unawareness on the brain’s resting state activity remains unclear.
Objective
To determine whether individuals with T1DM and hypoglycemia unawareness (T1DM-Unaware) had changes in the brain resting state functional connectivity compared to healthy controls (HC) and those with T1DM and hypoglycemia awareness (T1DM-Aware).
Design
Observational study
Setting
Academic medical center
Participants
27 individuals with T1DM and 12 healthy control volunteers participated in the study.
Intervention
All participants underwent BOLD resting state fMRI brain imaging during a 2-step hyperinsulinemic euglycemic (90 mg/dl)-hypoglycemic (60mg/dl) clamp.
Outcome
Changes in resting state functional connectivity
Results
Using two separate methods of functional connectivity analysis, we identified distinct differences in the resting state brain responses to mild hypoglycemia amongst HC, T1DM-Aware and T1DM-Unaware participants, particularly in the angular gyrus, an integral component of the default mode network (DMN). Furthermore, changes in angular gyrus connectivity also correlated with greater symptoms of hypoglycemia (r = 0.461, P = 0.003) as well as higher scores of perceived stress (r = 0.531, P = 0.016).
Conclusion
These findings provide evidence that individuals with T1DM have changes in the brain’s resting state connectivity patterns, which may be further associated with differences in awareness to hypoglycemia. These changes in connectivity may be associated with alterations in functional outcomes amongst individuals with T1DM.
Altered Brain Dynamics in Patients With Type 1 Diabetes During Working Memory Processing
