Glymphatic function and its influencing factors in different glucose metabolism states

doi:10.4239/wjd.v15.i7.1537

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World Journal of Diabetes

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1948-9358

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Diabetes. Jul 15, 2024; 15(7): 1537-1550
Published online Jul 15, 2024. doi: 10.4239/wjd.v15.i7.1537

Glymphatic function and its influencing factors in different glucose metabolism states

Bin Tian, Chen Zhao, Jia-Li Liang, Hui-Ting Zhang, Yi-Fan Xu, Hui-Lei Zheng, Jia Zhou, Jiang-Nian Gong, Shu-Ting Lu, Zi-San Zeng

Bin Tian, Jia-Li Liang, Yi-Fan Xu, Jiang-Nian Gong, Shu-Ting Lu, Zi-San Zeng, Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China

Chen Zhao, Magnetic Resonance Research Collaboration, Siemens Healthineers, Guangzhou 510620, Guangdong Province, China

Hui-Ting Zhang, Magnetic Resonance Research Collaboration, Siemens Healthineers Ltd., Wuhan 430071, Hubei Province, China

Hui-Lei Zheng, Department of Health Management, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China

Jia Zhou, Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China

Author contributions: Tian B and Zeng ZS designed and interpreted the complete data and were major contributors to writing the manuscript; Liang JL, Gong JN, Xu YF, and Lu ST helped to acquire the magnetic resonance images; Zheng HL and Zhou J helped to acquire the clinical data; Zhao C and Zhang HT assisted in processing the magnetic resonance images; Tian B was responsible for data analysis and manuscript writing; Zeng ZS was responsible for funding support and supervised the study; All authors read and approved the final manuscript.

Institutional review board statement: The participants in this study (No. 2023-K118-01) consisted of human individuals and were subjected to review and approval by the Medical Ethics Committee of The First Affiliated Hospital of Guangxi Medical University. This study has been registered in the Chinese Clinical Trial Registry (https://www.chictr.org.cn/bin/project/edit?pid=199727) with registration number ChiCTR2300075515 (date of registration:07/09/2023).

Informed consent statement: Before their involvement, the subjects provided their informed consent by signing a consent form, expressing their agreement to participate in the study.

Conflict-of-interest statement: The authors declare that this study was conducted without any business or financial relationship that could be interpreted as a potential conflict of interest.

Data sharing statement: Subject to the Research Ethics Committee’s discretion, clinical and neuroimaging data may be shared through contact communication channels upon reasonable request from a qualified investigator.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Corresponding author: Zi-San Zeng, MD, Chief Doctor, Professor, Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. zengzisan@aliyun.com

Received: February 26, 2024
Revised: May 13, 2024
Accepted: June 11, 2024
Published online: July 15, 2024
Processing time: 132 Days and 21.6 Hours

Abstract

BACKGROUND

Dysfunction of the glymphatic system in the brain in different stages of altered glucose metabolism and its influencing factors are not well characterized.

AIM

To investigate the function of the glymphatic system and its clinical correlates in patients with different glucose metabolism states, the present study employed diffusion tensor imaging along the perivascular space (DTI-ALPS) index.

METHODS

Sample size was calculated using the pwr package in R software. This cross-sectional study enrolled 22 patients with normal glucose metabolism (NGM), 20 patients with prediabetes, and 22 patients with type 2 diabetes mellitus (T2DM). A 3.0T magnetic resonance imaging was used to evaluate the function of the glymphatic system. The mini-mental state examination (MMSE) was used to assess general cognitive function. The DTI-ALPS index of bilateral basal ganglia and the mean DTI-ALPS index was calculated. Further, the correlation between DTI-ALPS and clinical features was assessed.

RESULTS

The left-side, right-side, and mean DTI-ALPS index in the T2DM group were significantly lower than that in the NGM group. The right-side DTI-ALPS and mean DTI-ALPS index in the T2DM group were significantly lower than those in the prediabetes group. DTI-ALPS index lateralization was not observed. The MMSE score in the T2DM group was significantly lower than that in the NGM and prediabetes group. After controlling for sex, the left-side DTI-ALPS and mean DTI-ALPS index in the prediabetes group were positively correlated with 2-hour postprandial blood glucose level; the left-side DTI-ALPS index was negatively correlated with total cholesterol and low-density lipoprotein level. The right-side DTI-ALPS and mean DTI-ALPS index were negatively correlated with the glycosylated hemoglobin level and waist-to-hip ratio in the prediabetes group. The left-side, right-side, and mean DTI-ALPS index in the T2DM group were positively correlated with height. The left-side and mean DTI-ALPS index in the T2DM group were negatively correlated with high-density lipoprotein levels.

CONCLUSION

Cerebral glymphatic system dysfunction may mainly occur in the T2DM stage. Various clinical variables were found to affect the DTI-ALPS index in different glucose metabolism states. This study enhances our understanding of the pathophysiology of diabetic brain damage and provides some potential biological evidence for its early diagnosis.

Keywords: Glymphatic system; Prediabetes; Type 2 diabetes mellitus; Magnetic resonance imaging; Diffusion tensor imaging along the perivascular space

Core Tip: Dysfunction of the glymphatic system in the brain in different stages of altered glucose metabolism is not well characterized. This study employed diffusion tensor imaging along the perivascular space (DTI-ALPS) index to investigate the function of the glymphatic system and its clinical correlates in patients with different glucose metabolism states. Cerebral glymphatic system dysfunction was found to mainly occur in overt diabetes mellitus. Various clinical variables were found to affect the DTI-ALPS index in different stages of impaired glucose metabolism.