Type 1 Diabetes: Retinopathy and Cerebral Microbleeds

MedicalResearch.com Interview with:
Dr. Eelco van Duinkerken
Vrije Universiteit Medical Center, Amsterdama

MedicalResearch.com: What are the main findings of the study?

Answer: In our study we assessed the relationship between cerebral small vessel disease and peripheral microvascular function in type 1 diabetes patients. By MRI cerebral small vessel disease was assessed as white matter hyperintensities and lacunar infarcts (markers of ischemia) and cerebral microbleeds (expression of vascular leakage). We hypothesized that subgroups, i.e. those with (proliferative) retinopathy, are more at risk to develop cerebral small vessels disease. To this end, we selected type 1 diabetes patients with proliferative retinopathy, type 1 diabetes patients without microvascular complications and healthy controls. The main finding of our study was that only cerebral microbleeds, but not ischemic markers of cerebral small vessel disease were more prevalent in type 1 diabetes patients with proliferative retinopathy relative to the other groups. Cerebral microbleeds were also related to microvascular function in skin. This suggest that cerebral microbleeds are part of generalized microangiopathy in patients with type 1 diabetes.

MedicalResearch.com: Were any of the findings unexpected?

Answer: The prevalence of markers of ischemic small vessels disease were not more prevalent in type 1 diabetes patient with proliferative retinopathy, only cerebral microbleeds were more prevalent. This was a somewhat unexpected finding, as the hypothesis was that small vessel disease in the brain is linked to vascular retinal damage. We speculated that this is due to the differences in aetiology of the lesions. White matter hyperintensities and lacunes are considered as markers of ischemia, whereas cerebral microbleeds represents hemosiderin leakage mainly at the capillary level and thus be more comparable to the microangiopathy measured in the retina and the skin. Although caution should be taken as only a small number of lesions were observed.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer: This report shows that microvascular functioning in the skin is related to vascular leakage in the brain, but only in type 1 diabetes patients with proliferative retinopathy. It shows that microvascular complications are part of a generalized microangiopathy. Thus, prevention of vascular complications is import to prevent type 1 diabetes related brain changes.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer: This is a first study in a limited sample to address the relationship between cerebral and peripheral vascular changes in type 1 diabetes. Further studies are needed in larger samples to understand the exact relationship between cerebral small vessel disease and peripheral vascular functioning. In such studies the effects of cerebral small vessel disease on brain functioning and cognitive functioning should be included.


Proliferative retinopathy in type 1 diabetes is associated with cerebral microbleeds, which is part of generalized microangiopathy.

Woerdeman J, van Duinkerken E, Wattjes MP, Barkhof F, Snoek FJ, Moll AC, Klein M, de Boer MP, Ijzerman RG, Serné EH, Diamant M.

Diabetes Care. 2013 Dec 6. [Epub ahead of print]


Last Updated on February 25, 2014 by Marie Benz MD FAAD