•  
  •  
 

Document Type

Conference Proceedings

Abstract

Objective: To review and synthesize current evidence examining how type 2 diabetes mellitus (P) affects the brain’s glymphatic “cleaning” system (E), leading to metabolic-waste accumulation, astroglial stress, and early cognitive and neuropathic outcomes (O). Methods: A scoping mini-review was performed of nine peer-reviewed studies (2021-2025) identified through PubMed and Scopus using diabetes, glymphatic system, aquaporin-4, ALPS index, spinal glymphatic, and metabolic syndrome. Eligible papers were English-language original or review articles assessing glymphatic flow, imaging biomarkers, or astroglial mechanisms in diabetes or related metabolic disorders. Data were synthesized narratively, and risk of bias was qualitatively evaluated. Results: In type 2 diabetes mellitus rat models (n = 24), MRI tracer studies showed ≈ 45-50% slower glymphatic clearance and early stagnation in the olfactory bulb and cortex. Painful diabetic-neuropathy rats exhibited ≈ 50% reduction in spinal cerebrospinal-fluid transport and nearly two-fold AQP4 polarity inversion. Among 52 older adults with metabolic syndrome, diffusion MRI revealed a 26% lower ALPS (Analysis Along the Perivascular Space) index - a noninvasive marker of perivascular flow - and ≈ 30% higher free-water, both correlating with fasting glucose and cognition. Conclusion: Most available data derives from animal studies but consistently indicates that diabetes weakens glymphatic clearance and disrupts AQP4 organization. Further human research is warranted to confirm these mechanisms and explore interventions that restore brain-cleaning capacity. Recognizing this clearance failure reframes diabetes as both a metabolic and neuroglial disorder and may inform new strategies to prevent cognitive and neuropathic complications.

Download

Share

COinS