Near normalization of metabolic and functional features of the central nervous system in type 1 diabetic patients with end-stage renal disease after kidney-pancreas transplantation.

"OBJECTIVEdThe pathogenesis of brain disorders in type 1 diabetes (T1D) is multifactorial. and involves the adverse effects of chronic hyperglycemia and of recurrent hypoglycemia. Kidneypancreas. (KP), but not kidney alone (KD), transplantation is associated with sustained normoglycemia,. improvement in quality of life, and reduction of morbidity\/mortality in diabetic. patients with end-stage renal disease (ESRD).. RESEARCH DESIGN AND METHODSdThe aim of our study was to evaluate with. magnetic resonance imaging and nuclear magnetic resonance spectroscopy (1H MRS) the cerebral. morphology andmetabolismof 15 ESRD plus T1Dpatients, 23 patientswith ESRD plus T1D. after KD (n = 9) and KP (n = 14) transplantation, and 8 age-matched control subjects.. RESULTSdMagnetic resonance imaging showed a higher prevalence of cerebrovascular disease. in ESRDplus T1D patients (53%[95%CI 36–69]) compared with healthy subjects (25%[3–6],. P = 0.04). Brain 1H MRS showed lower levels of N-acetyl aspartate (NAA)-to-choline ratio in ESRD. plus T1D, KD, and KP patients compared with control subjects (control subjects vs. all, P , 0.05). and ofNAA-to-creatine ratio in ESRD plus T1D compared with KP and control subjects (ESRD plus. T1D vs. control and KP subjects, P # 0.01). The evaluation of the most common scores of psychological. and neuropsychological function showed a generally better intellectual profile in control and. KP subjects compared with ESRD plus T1D and KD patients.. CONCLUSIONSdDiabetes and ESRD are associated with a precocious form of brain impairment,. chronic cerebrovascular disease, and cognitive decline. In KP-transplanted patients,. most of these features appeared to be near normalized after a 5-year follow-up period of sustained. normoglycemia"