More-severe diabetes was linked with smaller brain volumes and an increased chance of brain vascular pathology, according to a cross-sectional study involving >1,700 individuals. These associations were not seen in those with prediabetes and less-severe diabetes. Participants averaged 75 years of age; 30% had prediabetes and 35% diabetes. Investigators grouped them as follows: no diabetes, prediabetes, or diabetes (HbA1c < vs ≥7%). The latter group was also observed by diabetes duration (< vs ≥10 years). Among the results:

• Patients with prediabetes and less-severe diabetes did not have significantly different brain volumes or vascular pathology than those without diabetes.
• Patients with more-severe diabetes had smaller brain volumes and increased burden of white matter hyperintensities (WMH).
• Patients with more-severe diabetes had smaller total and regional brain volumes and an increased burden of WMH than those with less-severe diabetes.
• The same was true for those who had diabetes longer vs those with shorter disease duration.