Diabetes increases large artery diseases, but not small artery diseases in the brain

Background It is established that diabetes causes various systemic micro- and macro-vascular complications. Little has been, however, studied on the differential effects of diabetes on the large artery diseases (LAD) or small artery disease (SAD) in the brain. The purpose of this study was to examine an association of diabetes on the incidence of underlying LAD versus SAD in ischemic stroke patients. Methods We prospectively collected 523 acute ischemic stroke patients without cardioembolic causes or other determined causes of stroke. Using brain MRI, the cerebral LAD (extracranial and intracranial arterial stenosis of 50 % or more) and the cerebral SAD (old lacunar infarction, microbleeds and leukoaraiosis) findings were assessed. Information regarding vascular risk factor was also collected. Results Among the patients (male, n = 342; diabetes, n = 200), diabetes was not associated with the presence of LADs or SADs in female subjects, but strongly with the presence of intracranial LAD in male subjects (p < 0.01). The association remained significant (OR 2.09, 95 %CI 1.25–3.51) after adjusting for major confounders. A similar association was also found in intracranial LAD and insulin resistance. There was, however, no significant association of diabetes with SAD in male nor in female patients. Conclusions Our results showed that diabetes is associated with the frequency of intracranial LAD, especially in males. Out study may be regarded as evidence of differential biological effects of diabetes on cerebral vasculature.