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Brock C, Wegeberg AM, Nielsen TA, Karout B, Hellström PM, Drewes AM, Vorum H. The Retinal Nerve Fiber Layer Thickness Is Associated with Systemic Neurodegeneration in Long-Term Type 1 Diabetes. Transl Vis Sci Technol 2023; 12:23. [PMID: 37367720 DOI: 10.1167/tvst.12.6.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Purpose To determine whether the retinal nerve fiber layer thickness can be used as an indicator for systemic neurodegeneration in diabetes. Methods We used existing data from 38 adults with type 1 diabetes and established polyneuropathy. Retinal nerve fiber layer thickness values of four scanned quadrants (superior, inferior, temporal, and nasal) and the central foveal thickness were extracted directly from optical coherence tomography. Nerve conduction velocities were recorded using standardized neurophysiologic testing of the tibial and peroneal motor nerves and the radial and median sensory nerves, 24-hour electrocardiographic recordings were used to retrieve time- and frequency-derived measures of heart rate variability, and a pain catastrophizing scale was used to assess cognitive distortion. Results When adjusted for hemoglobin A1c, the regional thickness of the retinal nerve fiber layers was (1) positively associated with peripheral nerve conduction velocities of the sensory and motor nerves (all P < 0.036), (2) negatively associated with time and frequency domains of heart rate variability (all P < 0.033), and (3) negatively associated to catastrophic thinking (all P < 0.038). Conclusions Thickness of the retinal nerve fiber layer was a robust indicator for clinically meaningful measures of peripheral and autonomic neuropathy and even for cognitive comorbidity. Translational Relevance The findings indicate that the thickness of the retinal nerve fiber layer should be studied in adolescents and people with prediabetes to determine whether it is useful to predict the presence and severity of systemic neurodegeneration.
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Affiliation(s)
- Christina Brock
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Anne-Marie Wegeberg
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Thisted Research Unit, Aalborg University Hospital Thisted, Thisted, Denmark
| | - Thomas Arendt Nielsen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Per M Hellström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Asbjørn Mohr Drewes
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Henrik Vorum
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
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Gandhi R, Selvarajah D, Sloan G, Greig M, Wilkinson ID, Shaw PJ, Griffiths P, Tesfaye S. Preservation of thalamic neuronal function may be a prerequisite for pain perception in diabetic neuropathy: A magnetic resonance spectroscopy study. Front Pain Res (Lausanne) 2023; 3:1086887. [PMID: 36688084 PMCID: PMC9852821 DOI: 10.3389/fpain.2022.1086887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/24/2022] [Indexed: 01/09/2023]
Abstract
Introduction In this study, we used proton Magnetic Resonance Spectroscopy (1H-MRS) to determine the neuronal function in the thalamus and primary somatosensory (S1) cortex in different subgroups of DPN, including subclinical- and painful-DPN. Method One-hundred and ten people with type 1 diabetes [20 without DPN (no-DPN); 30 with subclinical-DPN; 30 with painful-DPN; and 30 with painless-DPN] and 20 healthy volunteers, all of whom were right-handed men, were recruited and underwent detailed clinical and neurophysiological assessments. Participants underwent Magnetic Resonance Imaging at 1.5 Tesla with two 1H-MRS spectra obtained from 8 ml cubic volume voxels: one placed within left thalamus to encompass the ventro-posterior lateral sub-nucleus and another within the S1 cortex. Results In the thalamus, participants with painless-DPN had a significantly lower NAA:Cr ratio [1.55 + 0.22 (mean ± SD)] compared to all other groups [HV (1.80 ± 0.23), no-DPN (1.85 ± 0.20), sub-clinical DPN (1.79 ± 0.23), painful-DPN (1.75 ± 0.19), ANOVA p < 0.001]. There were no significant group differences in S1 cortical neurometabolites. Conclusion In this largest cerebral MRS study in DPN, thalamic neuronal dysfunction was found in advanced painless-DPN with preservation of function in subclinical- and painful-DPN. Furthermore, there was a preservation of neuronal function within the S1 cortex in all subgroups of DPN. Therefore, there may be a proximo-distal gradient to central nervous system alterations in painless-DPN, with thalamic neuronal dysfunction occurring only in established DPN. Moreover, these results further highlight the manifestation of cerebral alterations between painful- and painless-DPN whereby preservation of thalamic function may be a prerequisite for neuropathic pain in DPN.
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Affiliation(s)
- Rajiv Gandhi
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Dinesh Selvarajah
- Department of Oncology and Human Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Gordon Sloan
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom,Department of Oncology and Human Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Marni Greig
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Iain D. Wilkinson
- Academic Unit of Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Pamela J. Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Paul Griffiths
- Academic Unit of Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Solomon Tesfaye
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom,Correspondence: Solomon Tesfaye
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Croosu SS, Røikjer J, Mørch CD, Ejskjaer N, Frøkjær JB, Hansen TM. Alterations in Functional Connectivity of Thalamus and Primary Somatosensory Cortex in Painful and Painless Diabetic Peripheral Neuropathy. Diabetes Care 2023; 46:173-182. [PMID: 36469731 DOI: 10.2337/dc22-0587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 10/13/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE In this study we aimed to investigate the functional connectivity of brain regions involved in sensory processing in diabetes with and without painful and painless diabetic peripheral neuropathy (DPN) and the association with peripheral nerve function and pain intensity. RESEARCH DESIGN AND METHODS In this cross-sectional study we used resting-state functional MRI (fMRI) to investigate functional brain connectivity of 19 individuals with type 1 diabetes and painful DPN, 19 with type 1 diabetes and painless DPN, 18 with type 1 diabetes without DPN, and 20 healthy control subjects. Seed-based connectivity analyses were performed for thalamus, postcentral gyrus, and insula, and the connectivity z scores were correlated with peripheral nerve function measurements and pain scores. RESULTS Overall, compared with those with painful DPN and healthy control subjects, subjects with type 1 diabetes without DPN showed hyperconnectivity between thalamus and motor areas and between postcentral gyrus and motor areas (all P ≤ 0.029). Poorer peripheral nerve functions and higher pain scores were associated with lower connectivity of the thalamus and postcentral gyrus (all P ≤ 0.043). No connectivity differences were found in insula (all P ≥ 0.071). CONCLUSIONS Higher functional connectivity of thalamus and postcentral gyrus appeared only in diabetes without neuropathic complications. Thalamic/postcentral gyral connectivity measures demonstrated an association with peripheral nerve functions. Based on thalamic connectivity, it was possible to group the phenotypes of type 1 diabetes with painful/painless DPN and type 1 diabetes without DPN. The results of the current study support that fMRI can be used for phenotyping, and with validation, it may contribute to early detection and prevention of neuropathic complications.
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Affiliation(s)
- Suganthiya S Croosu
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Johan Røikjer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Center for Neuroplasticity and Pain, SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Carsten D Mørch
- Center for Neuroplasticity and Pain, SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Niels Ejskjaer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens B Frøkjær
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Tine M Hansen
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Muthulingam JA, Brock C, Hansen TM, Drewes AM, Brock B, Frøkjær JB. Disrupted white matter integrity in the brain of type 1 diabetes is associated with peripheral neuropathy and abnormal brain metabolites. J Diabetes Complications 2022; 36:108267. [PMID: 35905510 DOI: 10.1016/j.jdiacomp.2022.108267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/23/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022]
Abstract
AIMS We aimed to quantify microstructural white matter abnormalities using magnetic resonance imaging and examine their associations with 1) brain metabolite and volumes and 2) clinical diabetes-specific characteristics and complications in adults with type 1 diabetes mellitus (T1DM) and distal symmetric peripheral neuropathy (DSPN). METHODS Diffusion tensor images (DTI) obtained from 46 adults with T1DM and DSPN and 28 healthy controls were analyzed using tract-based spatial statistics and were then associated with 1) brain metabolites and volumes and 2) diabetes-specific clinical characteristics (incl. HbA1c, diabetes duration, level of retinopathy, nerve conduction assessment). RESULTS Adults with T1DM and DSPN had reduced whole-brain FA skeleton (P = 0.018), most prominently in the inferior longitudinal fasciculus and retrolenticular internal capsule (P < 0.001). Reduced fractional anisotropy (FA) was associated with lower parietal N-acetylaspartate/creatine metabolite ratio (r = 0.399, P = 0.006), brain volumes (P ≤ 0.002), diabetes duration (r = -0.495, P < 0.001) and sural nerve amplitude (r = 0.296, P = 0.046). Additionally, FA was reduced in the subgroup with concomitant proliferative retinopathy compared to non-proliferative retinopathy (P = 0.03). No association was observed between FA and HbA1c. CONCLUSIONS This hypothesis-generating study provided that altered white matter microstructural abnormalities in T1DM with DSPN were associated with reduced metabolites central for neuronal communications and diabetes complications, indicating that peripheral neuropathic complications are often accompanied by central neuropathy.
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Affiliation(s)
| | - Christina Brock
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Tine Maria Hansen
- Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Asbjørn Mohr Drewes
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Centre for Pancreatic Diseases, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Birgitte Brock
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 2, 2820 Gentofte, Denmark
| | - Jens Brøndum Frøkjær
- Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Novo JL, Ruas JJ, Ferreira LM, Carvalho D, Barbosa M, Brandão S, de Bastos-Leite AJ. Thalamic volumetric abnormalities in type 1 diabetes mellitus and 'peripheral' neuropathy. Sci Rep 2022; 12:13053. [PMID: 35906253 DOI: 10.1038/s41598-022-16699-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/13/2022] [Indexed: 12/03/2022] Open
Abstract
We hypothesized that thalamic volumes of patients with type 1 diabetes mellitus (DM) and nonpainful diabetic peripheral neuropathy (DPN) would be reduced relative to thalamic volumes of patients with type 1 DM and painful DPN. We calculated the standardized thalamic volumetric difference between these groups in a pilot sample to obtain a statistical power of 80% at a 5% significance level. Hence, we measured thalamic volumes from 15 patients with nonpainful DPN (10 women, mean age = 49 years, standard deviation [SD] = 11.5) and from 13 patients with painful DPN (8 women, mean age = 43 years, SD = 12.5) by using a manual segmentation approach. A volumetric difference of approximately 15% was found between the nonpainful (mean = 5072 mm3, SD = 528.1) and painful (mean = 5976 mm3, SD = 643.1) DPN groups (P < 0.001). Curiously, a volumetric difference between the left (mean = 5198 mm3, SD = 495.0) and the right (mean = 4946 mm3, SD = 590.6) thalamus was also found in patients with nonpainful DPN (P < 0.01), but not in patients with painful DPN (P = 0.97). Patients with nonpainful DPN have lower thalamic volumes than those with painful DPN, especially in the right thalamus.
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Croosu SS, Hansen TM, Røikjer J, Mørch CD, Ejskjaer N, Frøkjær JB. Gray Matter Brain Alterations in Type 1 Diabetes - Findings Based on Detailed Phenotyping of Neuropathy Status. Exp Clin Endocrinol Diabetes 2022; 130:730-739. [PMID: 35668671 DOI: 10.1055/a-1835-1877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS This study investigated brain structure in patients of type 1 diabetes with diabetic peripheral neuropathy (DPN) and type 1 diabetes with neuropathic pain and the associations to clinical, peripheral, and cognitive measurements. METHODS Sixty individuals with type 1 diabetes and 20 healthy controls were included in the study. Nineteen individuals with type 1 diabetes and neuropathic pain, 19 with type 1 diabetes and DPN, 18 with type 1 diabetes without DPN, and 20 healthy controls were included in the brain analyses. We utilized structural brain magnetic resonance imaging to investigate total and regional gray matter volume. RESULTS Significant lower gray matter volume was found in type 1 diabetes with neuropathic pain and in type 1 diabetes without DPN compared to healthy controls (p=0.024 and p=0.019, respectively). Lower insula volume was observed in all three diabetes groups (all p≤0.050). Thalamus and hippocampus volume was lower in type 1 diabetes with neuropathic pain, cerebellum volume was lower in type 1 diabetes with DPN, and somatosensory cortex volume was lower in type 1 diabetes without DPN (all p≤0.018). Attenuated memory was associated with lower gray matter volume in type 1 diabetes with DPN. No associations were found between gray matter volume and clinical/peripheral measurements. CONCLUSION We demonstrated lower gray matter volume in individuals with type 1 diabetes regardless of the presence of DPN and neuropathic pain. Hence, central gray matter alteration was not associated with peripheral alterations.
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Affiliation(s)
- Suganthiya S Croosu
- Department of Radiology, Aalborg University Hospital, Hobrovej Aalborg, Denmark.,Steno Diabetes Center North Denmark, Aalborg University Hospital, Mølleparkvej Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej Aalborg, Denmark
| | - Tine M Hansen
- Department of Radiology, Aalborg University Hospital, Hobrovej Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej Aalborg, Denmark
| | - Johan Røikjer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Mølleparkvej Aalborg, Denmark.,Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej Aalborg, Denmark
| | - Carsten D Mørch
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej Aalborg, Denmark
| | - Niels Ejskjaer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Mølleparkvej Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej Aalborg, Denmark.,Department of Endocrinology, Aalborg University Hospital, Mølleparkvej Aalborg, Denmark
| | - Jens B Frøkjær
- Department of Radiology, Aalborg University Hospital, Hobrovej Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej Aalborg, Denmark
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Chitneni A, Rupp A, Ghorayeb J, Abd-Elsayed A. Early Detection of Diabetic Peripheral Neuropathy by fMRI: An Evidence-Based Review. Brain Sci 2022; 12:brainsci12050557. [PMID: 35624944 PMCID: PMC9139132 DOI: 10.3390/brainsci12050557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 01/13/2023] Open
Abstract
With the significant rise in the prevalence of diabetes worldwide, diabetic peripheral neuropathy (DPN) remains the most common complication among type 1 and 2 diabetics. The adverse sequelae of DPN, which include neuropathic pain, diabetic foot ulcers and lower-limb amputations, significantly impact quality of life and are major contributors to the biopsychosocial and economic burden of diabetes at the individual, societal and health system levels. Because DPN is often diagnosed in the late stages of disease progression by electromyography (EMG), and neuropathic pain as a result of DPN is difficult to treat, the need for earlier detection is crucial to better ascertain and manage the condition. Among the various modalities available to aid in the early detection of DPN, functional magnetic resonance imaging (fMRI) has emerged as a practical tool in DPN imaging due to its noninvasive radiation-free nature and its ability to relate real-time functional changes reflecting the local oxygen consumption of regions of the CNS due to external stimuli. This review aims to summarize the current body of knowledge regarding the utility of fMRI in detecting DPN by observing central nervous system (CNS) activity changes among individuals with DPN when compared to controls. The evidence to date points toward a tendency for increased activity in various central neuroanatomical structures that can be detected by fMRI and positively correlates with diabetic neuropathic pain.
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Affiliation(s)
- Ahish Chitneni
- Department of Rehabilitation and Regenerative Medicine, NewYork-Presbyterian Hospital—Columbia and Cornell, New York, NY 10065, USA
- Correspondence: (A.C.); (A.A.-E.); Tel.: +1-608-263-6039 (A.A.-E.)
| | - Adam Rupp
- Department of Physical Medicine and Rehabilitation, University of Kansas Health System, Kansas City, MO 66160, USA;
| | - Joe Ghorayeb
- Department of Physical Medicine and Rehabilitation, University of Medicine & Health Sciences, New York, NY 10001, USA;
| | - Alaa Abd-Elsayed
- Department of Anesthesia, Division of Pain Medicine, School of Medicine & Public Health, University of Wisconsin, Madison, WI 53726, USA
- Correspondence: (A.C.); (A.A.-E.); Tel.: +1-608-263-6039 (A.A.-E.)
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Croosu SS, Hansen TM, Brock B, Mohr Drewes A, Brock C, Frøkjær JB. Altered functional connectivity between brain structures in adults with type 1 diabetes and polyneuropathy. Brain Res 2022; 1784:147882. [DOI: 10.1016/j.brainres.2022.147882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 01/17/2022] [Accepted: 03/09/2022] [Indexed: 12/13/2022]
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