@article{27f77482ebca4814ac30c25ec11da48d,
title = "Altered functional connectivity during hypoglycaemia in type 1 diabetes",
abstract = "Behavioural responses to hypoglycaemia require coordinated recruitment of broadly distributed networks of interacting brain regions. We investigated hypoglycaemia-related changes in brain connectivity in people without diabetes (ND) and with type 1 diabetes with normal (NAH) or impaired (IAH) hypoglycaemia awareness. Two-step hyperinsulinaemic hypoglycaemic clamps were performed in 14 ND, 15 NAH and 22 IAH participants. BOLD timeseries were acquired at euglycaemia (5.0 mmol/L) and hypoglycaemia (2.6 mmol/L), with symptom and counter-regulatory hormone measurements. We investigated hypoglycaemia-related connectivity changes using established seed regions for the default mode (DMN), salience (SN) and central executive (CEN) networks and regions whose activity is modulated by hypoglycaemia: the thalamus and right inferior frontal gyrus (RIFG). Hypoglycaemia-induced changes in the DMN, SN and CEN were evident in NAH (all p < 0.05), with no changes in ND or IAH. However, in IAH there was a reduction in connectivity between regions within the RIFG (p = 0.001), not evident in the ND or NAH groups. We conclude that hypoglycaemia induces coordinated recruitment of the DMN and SN in diabetes with preserved hypoglycaemia awareness which is absent in IAH and ND. Changes in connectivity in the RIFG, a region associated with attentional modulation, may be key in impaired hypoglycaemia awareness.",
keywords = "Hypoglycaemia, impaired awareness of hypoglycaemia, neuroimaging, resting state networks, type 1 diabetes",
author = "Peter Jacob and Munachiso Nwokolo and Cordon, {Sally M.} and Macdonald, {Ian A.} and Zelaya, {Fernando O.} and Amiel, {Stephanie A.} and Owen O{\textquoteright}Daly and Pratik Choudhary",
note = "Funding Information: The authors thank the participants; the diabetes research nurses, Andrew Pernet, Bula Wilson, Marcia Henderson-Wilson; the clinical research nurses at the NIHR and Wellcome Trust Clinical Research Facility, Louisa Green and John Lord Villajin; and the radiographers and administrative staff at the Centre for Neuroimaging Sciences, King{\textquoteright}s College London. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Hypoaware was funded by Diabetes UK (grant number 13/0004653). HARPscan (the neuroimaging study around the HARPdoc study) and HARPdoc were funded by the Juvenile Diabetes Research Foundation (HARPscan grant number 3-SRA-2017-484-S-B, HARPdoc grant number 4- SRA-2017-266-M-N). The funder had no role in the study design, data collection, analysis, decision to publish or preparation of the manuscript. Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Hypoaware was funded by Diabetes UK (grant number 13/0004653). HARPscan (the neuroimaging study around the HARPdoc study) and HARPdoc were funded by the Juvenile Diabetes Research Foundation (HARPscan grant number 3-SRA-2017-484-S-B, HARPdoc grant number 4- SRA-2017-266-M-N). The funder had no role in the study design, data collection, analysis, decision to publish or preparation of the manuscript. Acknowledgements Publisher Copyright: {\textcopyright} The Author(s) 2022.",
year = "2022",
month = aug,
doi = "10.1177/0271678X221082911",
language = "English",
volume = "42",
pages = "1451--1462",
journal = "Journal of Cerebral Blood Flow and Metabolism",
issn = "0271-678X",
publisher = "Nature Publishing Group",
number = "8",
}
