Cerebral microvascular disease in diabetes - clinical and research

Peripheral microvascular complications, such as retinopathy, are well known and well studied. Microvascular complications in the brains of patients with either type 1 or type 2 diabetes have been awarded much less attention, and systematic research into this area is something that only has begun in the past two to three decades, helped by the rapid development of magnetic resonance imaging (MRI). In this chapter we will discuss the current state of the literature on (microvascular) brain problems in both types of diabetes. We will first describe findings of studies assessing the presence and severity of cerebral small vessel disease and how this is related to cognitive problems, stroke, and the risk of dementia in patients with diabetes. We will further briefly highlight the most important findings of studies into brain volume, white matter microstructure, and functional communication between brain regions (or functional connectivity), how these are related to central and peripheral microangiopathy, and how they interact with daily cognitive functioning. Lastly, we will discuss the implications of these finding for personalized treatment and future research.