{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T17:10:34Z","timestamp":1779210634038,"version":"3.51.4"},"reference-count":55,"publisher":"American Society for Clinical Investigation","issue":"8","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":55,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["P41-EB-015894,P30-NS-076408,R01-DK-099137,R56-DK-099137"],"award-info":[{"award-number":["P41-EB-015894,P30-NS-076408,R01-DK-099137,R56-DK-099137"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"crossref","award":["KL2-TR-000113,UL1-TR-000114"],"award-info":[{"award-number":["KL2-TR-000113,UL1-TR-000114"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,15]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Recurrent hypoglycemia in type 1 diabetes (T1D) may culminate in impaired awareness of hypoglycemia (IAH). While neuroimaging studies identified affected brain regions, more complex perspectives integrating vascular dynamics with endocrine profile are needed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Here, 26 healthy adults, 30 T1D patients with normal hypoglycemia awareness (NAH), and 25 T1D patients with IAH underwent a hyperinsulinemic stepped clamp (euglycemia \u2192 hypoglycemia 50 mg\/dL) combined with pseudo-continuous arterial spin-labeling MRI. Cerebral blood flow (CBF) and sympathetic vasomotor range (0.02\u20130.05 Hz) CBF oscillations were modeled against serially sampled plasma cortisol, epinephrine, norepinephrine, and glucagon.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      In healthy individuals treated as controls, hypoglycemia evoked robust thalamo-striatal and salience\u2013interoceptive CBF increases (mean Cohen\u2019s\n                      <jats:italic>d<\/jats:italic>\n                      across significant clusters = 0.93) and suppression of vasomotor oscillations (\n                      <jats:italic>d<\/jats:italic>\n                      = 0.71). T1D retained CBF response but failed to attenuate oscillations (\n                      <jats:italic>\n                        d\n                        <jats:sub>T1D&gt;controls<\/jats:sub>\n                      <\/jats:italic>\n                      = 0.43). IAH further blunted hypoglycemia-associated CBF increase, especially in thalamus, striatum, and insula (\n                      <jats:italic>\n                        d\n                        <jats:sub>NAH&gt;IAH<\/jats:sub>\n                      <\/jats:italic>\n                      = 0.51). Hormone-CBF coupling differed quantitatively: cortisol\/epinephrine\u2013CBF correlations were positive in controls (\n                      <jats:italic>r<\/jats:italic>\n                      = 0.37\/0.26), negative in NAH (\u20130.16\/\u20130.40), and strongly positive in IAH (0.42\/0.46).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Thus, our findings indicate that T1D disrupts dynamic, sympathetic modulation of CBF, whereas IAH additionally impairs perfusion reserve and shows maladaptive catecholamine-dependent CBF regulation, suggesting a qualitatively distinct neurovascular phenotype.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>TRIAL REGISTRATION<\/jats:title>\n                    <jats:p>ClinicalTrials.gov: NCT02747680 and NCT02866435.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>FUNDING<\/jats:title>\n                    <jats:p>NIH (P41-EB-015894, P30-NS-076408, R01-DK-099137, R56-DK-099137, and DP1 AG093028); National Center for Advancing Translational Sciences of the NIH (KL2-TR-000113 and UL1-TR-000114); DP1 AG093028; Charles University, Czech Republic (Cooperatio Program, research area NEUR), Brain Dynamics (grant number CZ.02.01.01\/00\/22_008\/0004643); General University Hospital in Prague (MH CZ-DRO-VFN64165).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1172\/jci199725","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T17:00:32Z","timestamp":1771520432000},"source":"Crossref","is-referenced-by-count":1,"title":["Disrupted neurovascular-endocrine coupling in type 1 diabetes with impaired awareness of hypoglycemia"],"prefix":"10.1172","volume":"136","author":[{"given":"Pavel","family":"Filip","sequence":"first","affiliation":[{"name":"Center for Magnetic 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