Size of the Cerebral Ventricular System in Patients Affected by Type 2 Diabetes Mellitus: A Retrospective Observational Study

Aim: This study is aimed at determining the prevalence of patients with Type 2 diabetes mellitus (T2DM) affected by abnormal ventricular enlargement (normal pressure hydrocephalus).

Materials and Methods: Data were collected on diabetic patients from an outpatient diabetology clinic and nondiabetic patients who underwent brain CT or MRI, including sex, age, diabetes onset date, fasting blood glucose, HbA1c, Evans Index, and the time between diabetes diagnosis and neuroimaging. The metabolic profile was assessed by BMI, blood pressure, waist circumference, glomerular filtration rate, total cholesterol, LDL, HDL, and triglycerides. The use of ongoing therapies was recorded and categorized by drug class. Common comorbidities, such as ischemic heart disease, diabetic retinopathy, renal failure, and carotid atherosclerosis, were also documented.

Results: Neuroradiological data were available for 272 diabetic patients (mean age: 71.6 ± 11.2 years) and 275 nondiabetic patients (mean age: 70.4 ± 12.5 years). Pathological ventricular enlargement was identified in 116 of 547 individuals (21%), with a higher prevalence among males (68%; p = 0.002). Ventricular enlargement was noted in 25% of diabetic patients and 17.1% of nondiabetic patients (p = 0.02). Diabetic patients with ventricular enlargement were significantly older (mean age: 76.9 years vs. 69.4 years) than those without enlargement (p = 0.01). The duration of diabetes was also significantly longer in patients with enlargement (mean: 16.5 years) compared to those without (p = 0.009). Age, male sex, longer diabetes duration, history of ischemic heart disease, beta-blocker use, and antiplatelet therapy were significantly associated with a pathological Evans Index. In multivariate analysis, antiplatelet therapy was the strongest predictor of abnormal ventricular enlargement in T2DM patients after adjusting for confounding factors (p = 0.01).

Conclusion: There is a high prevalence of pathological ventricular enlargement in patients with T2DM. Advanced age, male sex, longer disease duration, and the use of antiplatelet therapy are significantly associated with abnormal ventricular enlargement.