Diabetes, Prediabetes Linked to Older Brain Age
Patients with diabetes and prediabetes have older brain ages than their chronological age compared with normoglycemic patients.
Diabetes and prediabetes are both associated with a widened gap between brain age and chronological age, according to a new study published in Diabetes Care.1
Diabetes, Prediabetes Linked to Older Brain Age / jolygon - stock.adobe.com
The results also indicated that healthy lifestyle factors, including not smoking, limited drinking, and high physical activity, can help mitigate this gap.
While diabetes has been well-established as a risk factor for dementia, the role of prediabetes has not been explored. In their study, the researchers wanted to explore the link between prediabetes and brain aging, as well as factors that may reduce brain aging.
The study included 31229 patients aged 40 to 70 years from the UK Biobank who did not have dementia. For the baseline examination, participants underwent physical and medical assessments at 22 assessment centers. Patients also completed questionnaires about sociodemographic and lifestyle factors. After about 9 years, participants underwent a brain MRI scan, with some participants undergoing a second brain MRI scan.
READ MORE: Micronutrient Deficiencies Common Among Patients With Type 2 Diabetes
The researchers used a machine learning model based on 1079 brain MRI phenotypes to estimate participants’ brain age. To calculate the brain age gap (BAG), researchers subtracted participants’ chronological age from their brain age.
At baseline, 13518 patients (43.3%) had prediabetes, and 1149 (3.7%) had diabetes. The results indicated that both prediabetes and diabetes were associated with significantly higher BAGs compared with normoglycemia. Participants with diabetes had an average BAG of 2.29 years older than chronological age, while those with prediabetes had an average BAG of 0.50 years older. Participants with poorly controlled diabetes (HbA1c ≥8.0%) had a BAG of up to 4.18 years. As a continuous variable, HbA1c levels were associated with significantly higher BAG.
After performing stratified analysis, the researchers found that the association between diabetes and higher BAG was stronger in male participants—men with diabetes had a BAG of 2.63 years compared with 1.76 for women. This was true with prediabetes as well, with men having a BAG of 0.75 years older compared with 0.27 for women. Participants with a higher burden of cardiometabolic risk factors had a BAG of 3.08 years for those with diabetes and 1.32 for those with prediabetes. Those who did not have cardiometabolic risk factors had BAGs of 1.96 years for diabetes and 0.24 for prediabetes.
In a joint exposure analysis, the researchers found that a healthy lifestyle significantly mitigated the association between BAG and diabetes. Healthy lifestyle factors included nonsmoking, no or light/moderate drinking, and high physical activity. For participants with diabetes, those with a healthy lifestyle had a BAG of only 0.78 years compared with 2.46 years for those with a nonoptimal lifestyle. While a healthy lifestyle slightly reduced BAG in those with prediabetes or normoglycemia, the effect was not statistically significant.
Using data from participants who underwent 2 MRI brain scans, the researchers determined that diabetes was associated with a 0.27-year annual increase in BAG over time. The results indicated that diabetes not only impacts brain age; it also accelerates the rate of brain aging.
Because prediabetes is a reversible state, the researchers hope that their results provide another incentive for patients to improve their glycemic control. Patients with diabetes and prediabetes should be targeted for lifestyle interventions in order to improve brain health.
READ MORE: Diabetes Resource Center
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