BMJ OPEN DIABETES & RESEARCH CARE

Sampedro F, Stantonyonge N, Martínez-Horta S, Alcolea D, Lleó A, Muñoz L, Pérez-González R, Marín-Lahoz J, Gómez-Ansón B and Chico A.

BMJ Open Diabetes Res Care. 2020 Jul;8(1):e001516.

DOI: 10.1136/bmjdrc-2020-001516

Abstract

Introduction: 

Impaired awareness of hypoglycemia (IAH) is a common complication in patients with type-1 diabetes (T1D). IAH is a major risk factor for severe hypoglycemic events, leading to adverse clinical consequences and cerebral damage. Non-invasive, cost-effective, and logistically efficient biomarkers for this condition have not been validated. Here, we propose plasma neurofilament light chain (NfL) levels as a biomarker of neuroaxonal damage in patients with T1D-IAH.

Research design and methods: 

54 patients were included into the study (18 T1D-IAH, 18 T1D with normal awareness of hypoglycemia (NAH) and 18 healthy controls). We measured plasma NfL levels and studied cerebral gray matter alterations on MRI.

Results: 

We found that NfL levels were increased in patients with T1D-IAH compared with patients with T1D-NAH and healthy controls. Importantly, increased NfL levels correlated with reduced cerebral gray matter volume and increased IAH severity in patients with T1D-IAH.

Conclusion: 

Overall, our findings identify plasma NfL levels as a potential biomarker of cerebral damage in this population, motivating further confirmatory studies with potential implications in clinical trials.