Abstract：
BACKGROUND: Insulin resistance is widely thought to be a critical feature in type 2 diabetes mellitus (T2DM), and there is significant evidence indicating a higher abundance of insulin receptors in the human cerebellum than cerebrum. However, the specific structural or functional changes in the cerebellum related to T2DM remain unclear, and the association between cerebellar alterations, insulin resistance, cognition, and emotion is yet to be determined.
METHODS: We investigated neuropsychological performance, and structural and functional changes in specific cerebellar subregions in 43 T2DM patients with high insulin resistance (T2DM-highIR), 72 T2DM patients with low insulin resistance (T2DM-lowIR), and 50 controls. Furthermore, the correlation and stepwise multiple linear regression analysis were performed.
RESULTS: Compared to the controls, T2DM exhibited lower cognitive scores and higher depressive/anxious scores. Furthermore, T2DM-highIR patients showed reduced gray matter volume (GMV) in the right cerebellar lobules VIIb, Crus I/II, and T2DM showed reduced GMV in left lobules I-IV compared to controls. Additionally, functional connectivity decrease was observed between the right lobules I-V and orbital part of the superior frontal gyrus in T2DM-highIR compared to both T2DM-lowIR and controls. Notably, there were negative correlations between the GMV of the lobules VIIb, Crus I/II, and updated homeostatic model assessment of insulin resistance, and positive correlation with executive/visuospatial performance in T2DM patients.
CONCLUSIONS: These results suggest that the cerebellar lobules VIIb, Crus I/II, represent vulnerable brain regions in the context of insulin resistance. Overall, this study offers new insights into the neuropathophysiological mechanisms of brain impairment in patients with T2DM.
METHODS: We investigated neuropsychological performance, and structural and functional changes in specific cerebellar subregions in 43 T2DM patients with high insulin resistance (T2DM-highIR), 72 T2DM patients with low insulin resistance (T2DM-lowIR), and 50 controls. Furthermore, the correlation and stepwise multiple linear regression analysis were performed.
RESULTS: Compared to the controls, T2DM exhibited lower cognitive scores and higher depressive/anxious scores. Furthermore, T2DM-highIR patients showed reduced gray matter volume (GMV) in the right cerebellar lobules VIIb, Crus I/II, and T2DM showed reduced GMV in left lobules I-IV compared to controls. Additionally, functional connectivity decrease was observed between the right lobules I-V and orbital part of the superior frontal gyrus in T2DM-highIR compared to both T2DM-lowIR and controls. Notably, there were negative correlations between the GMV of the lobules VIIb, Crus I/II, and updated homeostatic model assessment of insulin resistance, and positive correlation with executive/visuospatial performance in T2DM patients.
CONCLUSIONS: These results suggest that the cerebellar lobules VIIb, Crus I/II, represent vulnerable brain regions in the context of insulin resistance. Overall, this study offers new insights into the neuropathophysiological mechanisms of brain impairment in patients with T2DM.
摘要：
背景：胰岛素抵抗被广泛认为是2型糖尿病（T2DM）的关键特征，并且有大量证据表明人类小脑中胰岛素受体的丰度高于大脑。然而,与T2DM相关的小脑的具体结构或功能变化尚不清楚,和小脑改变之间的联系，胰岛素抵抗，认知，情绪尚未确定。
方法：我们调查了神经心理学表现，结构,43例高胰岛素抵抗(T2DM-highIR)的T2DM患者小脑特定亚区功能改变,72名具有低胰岛素抵抗（T2DM-lowIR）的T2DM患者，50个控制此外，进行相关性和逐步多元线性回归分析.
结果：与对照组相比，T2DM表现出更低的认知评分和更高的抑郁/焦虑评分。此外，T2DM-highIR患者显示右侧小脑小叶VIIb的灰质体积(GMV)减少,CrusI/II,与对照相比,T2DM显示左小叶I-IV中GMV降低。此外,与T2DM-lowIR和对照组相比，T2DM-highIR中的右小叶I-V和额上回眶部分之间的功能连通性降低。值得注意的是,小叶VIIb的GMV之间存在负相关，CrusI/II和更新的胰岛素抵抗稳态模型评估，与T2DM患者的执行/视觉空间表现呈正相关。
结论：这些结果表明小脑小叶VIIb，CrusI/II代表胰岛素抵抗背景下的脆弱大脑区域。总的来说,这项研究为2型糖尿病患者脑损伤的神经病理生理机制提供了新的见解.
方法：我们调查了神经心理学表现，结构,43例高胰岛素抵抗(T2DM-highIR)的T2DM患者小脑特定亚区功能改变,72名具有低胰岛素抵抗（T2DM-lowIR）的T2DM患者，50个控制此外，进行相关性和逐步多元线性回归分析.
结果：与对照组相比，T2DM表现出更低的认知评分和更高的抑郁/焦虑评分。此外，T2DM-highIR患者显示右侧小脑小叶VIIb的灰质体积(GMV)减少,CrusI/II,与对照相比,T2DM显示左小叶I-IV中GMV降低。此外,与T2DM-lowIR和对照组相比，T2DM-highIR中的右小叶I-V和额上回眶部分之间的功能连通性降低。值得注意的是,小叶VIIb的GMV之间存在负相关，CrusI/II和更新的胰岛素抵抗稳态模型评估，与T2DM患者的执行/视觉空间表现呈正相关。
结论：这些结果表明小脑小叶VIIb，CrusI/II代表胰岛素抵抗背景下的脆弱大脑区域。总的来说,这项研究为2型糖尿病患者脑损伤的神经病理生理机制提供了新的见解.
