Transcranial Doppler Analysis Reveals Impaired Cerebral Autoregulation in Type 2 Diabetes
Albara Alotaibi1, ABDEL RAHMAN ALKASABRAH2
1Faculty of medicine, Jordan University of Science and Technology, 2Neurology, University of Connecticut
Objective:
To determine whether Type 2 Diabetes Mellitus (T2DM) is associated with impaired cerebral blood flow regulation during orthostatic stress
Background:
Patients with T2DM are at increased risk for cerebrovascular dysfunction and cognitive decline. Dynamic cerebral autoregulation during postural stress may provide mechanistic insights, but physiologic evidence is limited.
Design/Methods:
We analyzed recordings from the Cerebral Perfusion in Diabetes open-access dataset (PhysioNet, n=52). Transcranial Doppler signals from right and left middle cerebral arteries (MCA-R, MCA-L) were extracted during head-up tilt testing. Experimental phases (baseline vs tilt) were defined using marker channels. Mean velocities were calculated per phase, and percentage change was computed (Δ% = 100 × [Tilt–Baseline]/ Baseline). Subjects were linked with clinical metadata (age, sex, diabetes duration, hypertension, cognition). Group differences and subgroup analyses were assessed with t-tests
Results:
• Diabetes vs Control: MCA-R autoregulation was significantly impaired in T2DM (mean Δ% -3.1 vs +2.8, p = 0.0125). MCA-L showed a nonsignificant trend (Δ% -2.5 vs +1.9, p = 0.0687).
• Outliers: 25–35% of subjects exhibited >±10% changes, suggesting heterogeneity of autoregulation.
• Subgroups: Longer diabetes duration (mean -3.6% vs -2.3%) and hypertension (mean -3.6% vs -0.3%) were associated with numerically greater impairment, though not statistically significant. No consistent effects of age, sex, or cognition were observed
Conclusions:
Type 2 Diabetes is associated with impaired cerebral blood flow regulation during orthostatic stress, most prominently in the right MCA. Vascular risk factors such as hypertension and longer disease duration may further contribute to autoregulatory dysfunction. These findings highlight diabetes-related cerebrovascular vulnerability and support further investigation into its role in cognitive decline
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