Impact of Fasting Glycemia and Regional Cerebral Perfusion in Diabetic Subjects. A Study With Technetium-99m-Ethyl Cysteinate Dimer Single Photon Emission Computed Tomography

BACKGROUND AND PURPOSE: Diabetes mellitus increases the risk of ischemic stroke. The aim of this study was to investigate the correlation between fasting plasma glucose (FPG) and changes in regional cerebral perfusion (CP) in subjects with DM. METHODS: CP was assessed in 24 subjects (mean age 44±2.5 years) with type 1 diabetes mellitus by single photon emission computed tomography. RESULTS: Analysis of CP during elevated FPG (224±24 mg/dL) showed 3 or more deficits in 42% of the subjects. A positive relationship between the number of CP deficits and FPG was observed (P<0.01), but not with age, sex, body mass index, or duration of diabetes mellitus. Regional deficits were reduced (P<0.001) with improvement in FPG (119±5 mg/dL). This reduction remained significant after adjustment for age, sex, and body mass index. Plasma levels of P-selectin, intercellular adhesion molecule-1, and vascular cell adhesion molecule-1, established markers of endothelial dysfunction, were significantly decreased with lower FPG. Furthermore, thiobarbituric acid reactive substance plasma levels, an index of oxidative stress, were also reduced (P<0.01). CONCLUSIONS: The present study demonstrates that changes in FPG are associated with functional changes in regional CP. Hyperglycemia-induced endothelial dysfunction may be implicated in the impaired regional CP of diabetic subjects.