Diabetes and MRI Infarction in the Hispanic Community Health Study, Study of Latinos

Abstract

Introduction: HCHS/SOL is a representative study of Hispanic/Latinos living in the US. HCHS/SOL participants have a high prevalence of diabetes (1) and diabetic associated cognitive decline (2). Previous studies of predominantly non-Hispanic White populations indicate that silent brain infarcts are associated with incident dementia (3). Given that diabetes is prevalent in HCHS/SOL and associated with cognitive decline, we examined whether diabetes may also lead to infarction on MRI. Methods: SOL-INCA-MRI consists of 2668 individuals of Hispanic/Latino Heritage from 4 centers across the US. Demographics of the cohort are summarized in the Table. The presence or absence of infarction on MRI was determined from review of high resolution T1, T2 and FLAIR imaging as well as gradient echo imaging by a neuroradiologist and a stroke neurologist with a high level of agreement (ICC >0.90). Desperate readings were adjudicated by a neurologist with experience in vascular brain injury. Diabetes based on American Diabetes Association definition of normal, prediabetic and diabetic. This definition used measures serum glucose levels adjusted for fasting time and, if available, post-OGTT glucose levels, A1C percentages, and scanned/transcribed anti- diabetic medication use. General linear model was used to test the associated between the presence or absence of MRI and diabetes adjusting for age, gender, heritage, and center. Results: Subjects were 62.3 + 9.2 years of age at MRI range [35-86], 67% were female and the prevalence of MRI infarction was 7% (Table). Pre-diabetes was present in 45% and diabetes in 22%. Stroke prevalence increased with age ranging from <1% at age 40 to 18% at age 80 (Figure 1). Diabetes or pre-diabetes prevalence also increased with age being 10% at 40 and over 60% at age 80 (Figure 2). Adjusting for age, men were 2 times more likely to be diabetic. In the full model, age, gender, and diabetes were significantly associated with infarction seen on MRI with the likelihood of infarction 1.9 times greater in persons with diabetes. Discussion: These results indicate that the presence of diabetes is strongly associated with infarction on MRI in Hispanic/Latinos in the US. This association may explain, in part, the association between diabetes and cognitive decline.