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Diabetes and prediabetes are associated with accelerated brain aging, with differences in brain age of 2.29 and 0.50 years, respectively. This association is more pronounced in men and those with poorer cardiometabolic health, but may be mitigated by a healthy lifestyle.
Methodology:
Diabetes is a known risk factor for cognitive impairment, dementia, and overall brain atrophy, but conflicting results have been reported for prediabetes, and it is unclear whether a healthy lifestyle can counteract the deleterious effects of prediabetes. Researchers investigated the cross-sectional and longitudinal relationship between hyperglycemia and brain ageing, and the potential moderating effect of a healthy lifestyle, in 31,229 dementia-free adults (mean age 54.8 years, 53% women) from the UK Biobank. This included 13,518 participants with prediabetes and 1149 participants with diabetes. Participants’ glycemic status was determined by medical history, medication, and A1c levels. Brain age gaps were calculated as the difference between chronological age and brain age estimated from MRI data from six modalities and compared with hundreds of brain MRI phenotypes modeled from a subset of healthy individuals. Associations of gender, cardiometabolic risk factors, and a healthy lifestyle with brain age were also explored, where a healthy lifestyle was defined as not smoking, drinking no or low or moderate alcohol, and engaging in vigorous physical activity.
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Prediabetes and diabetes were associated with a higher brain age gap than euglycemia (beta coefficients, 0.22 and 2.01, respectively; 95% CI, 0.10-0.34 and 1.70-2.32, respectively). Diabetes was also more pronounced in men than women and in individuals with a lower than a higher burden of cardiometabolic risk factors. Brain ages in individuals with prediabetes and diabetes were, on average, 0.50 and 2.29 years higher than their respective chronological ages. In an exploratory longitudinal analysis of 2,414 participants who underwent two brain MRI scans, diabetes was associated with a 0.27-year increase in the brain age gap per year, and higher A1C, but not prediabetes, was associated with a significant increase in the brain age gap. A healthy lifestyle attenuated (P = .003) the association between diabetes and a higher brain age gap, reducing it by 1.68 years, and also showed a significant interaction between prediabetes and diabetes. Glycemic status and lifestyle.
Exercise:
“Our findings highlight that diabetes and prediabetes are ideal targets for lifestyle-based interventions to promote brain health,” the authors wrote.
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The study was led by Abigail Dove of the Centre for Ageing Research, Department of Neurobiology, Care Science and Sociology, Karolinska Institutet, Stockholm, Sweden, and was published online in the journal Diabetes Care.
Limitations:
The bias of healthy volunteers in the UK Biobank limited the generalizability of the findings. A high rate of missing data prevented us from including diet in the construct of a healthy lifestyle. Reverse causation is possible, as brain ageing may lead to difficulties in managing medical conditions and maintaining a healthy lifestyle, which may lead to the development of prediabetes. A1c levels were only measured at baseline, so changes in glycemic control over time could not be assessed.
Disclosure:
The authors reported receiving funding from the Swedish Research Council, the Swedish Research Council for Health, Working Life and Welfare, the Karolinska Institutet Research Board, the Riksbank Memorial Fund, the Marianne and Marcus Wallenberg Foundation, the Alzheimer’s Fund and the Demens Fund. The authors stated that they had no relevant conflicts of interest.
This article was created using multiple editorial tools, including AI as part of the process; a human editor reviewed this content before publishing.