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Title: Abnormal Responses in Cognitive Impulsivity Circuits Are Associated with Glycosylated Hemoglobin Trajectories in Type 1 Diabetes Mellitus and Impaired Metabolic Control
Authors: Jorge, Helena 
Duarte, Isabel C. 
Paiva, Sandra 
Relvas, Ana Paula 
Castelo-Branco, Miguel 
Keywords: Decision making; Diabetes mellitus type 1; Glycated hemoglobin A; Impulsive behavior; Risk factors; Treatment adherence and compliance
Issue Date: 22-Mar-2022
Publisher: Korean Diabetes Association
Project: UID/4950/2020 
FIS-FIS-2015-01 DIA - DiaMarkData 
European Foundation for the Study of Diabetes (EFSD) 2019—Innovative Measurement of Diabetes Outcomes 2019 
Serial title, monograph or event: Diabetes & Metabolism Journal
Place of publication or event: Seoul
Abstract: Background: Risky health decisions and impulse control profiles may impact on metabolic control in type 1 diabetes mellitus (T1DM). We hypothesize that the neural correlates of cognitive impulsivity and decision-making in T1DM relate to metabolic control trajectories. Methods: We combined functional magnetic resonance imaging (fMRI), measures of metabolic trajectories (glycosylated hemoglobin [HbA1c] over multiple time points) and behavioral assessment using a cognitive impulsivity paradigm, the Balloon Analogue Risk Task (BART), in 50 participants (25 T1DM and 25 controls). Results: Behavioral results showed that T1DM participants followed a rigid conservative risk strategy along the iterative game. Imaging group comparisons showed that patients showed larger activation of reward related, limbic regions (nucleus accumbens, amygdala) and insula (interoceptive saliency network) in initial game stages. Upon game completion differences emerged in relation to error monitoring (anterior cingulate cortex [ACC]) and inhibitory control (inferior frontal gyrus). Importantly, activity in the saliency network (ACC and insula), which monitors interoceptive states, was related with metabolic trajectories, which was also found for limbic/reward networks. Parietal and posterior cingulate regions activated both in controls and patients with adaptive decision-making, and positively associated with metabolic trajectories. Conclusion: We found triple converging evidence when comparing metabolic trajectories, patients versus controls or risk averse (non-learners) versus patients who learned by trial and error. Dopaminergic reward and saliency (interoceptive and error monitoring) circuits show a tight link with impaired metabolic trajectories and cognitive impulsivity in T1DM. Activity in parietal and posterior cingulate are associated with adaptive trajectories. This link between reward-saliency-inhibition circuits suggests novel strategies for patient management.
Description: Published online: March 22, 2022
ISSN: 2233-6087
DOI: 10.4093/dmj.2021.0307
Rights: openAccess
Appears in Collections:I&D CES - Artigos em Revistas Internacionais

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