{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:00:13Z","timestamp":1791388813010,"version":"4.3.3"},"reference-count":52,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T00:00:00Z","timestamp":1741219200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and objectives: Type 2 diabetes mellitus (T2DM) affects brain white matter microstructure. While diffusion tensor imaging (DTI) has been used to study white matter abnormalities in T2DM, it lacks specificity for complex white matter tracts. Neurite orientation dispersion and density imaging (NODDI) offers a more specific approach to characterising white matter microstructures. This study aims to explore white matter alterations in T2DM using both DTI and NODDI and assess their association with disease duration and glycaemic control, as indicated by HbA1c levels. Methods and Materials: We analysed white matter microstructure in 48 tracts using data from the UK Biobank, involving 1023 T2DM participants (39% women, mean age 66) and 30,744 non-T2DM controls (53% women, mean age 64). Participants underwent 3.0T multiparametric brain imaging, including T1-weighted and diffusion imaging for DTI and NODDI. We performed region-of-interest analyses on fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), orientation dispersion index (ODI), intracellular volume fraction (ICVF), and isotropic water fraction (IsoVF) to assess white matter abnormalities. Results: We observed reduced FA and ICVF, and increased MD, AD, RD, ODI, and IsoVF in T2DM participants compared to controls (p &lt; 0.05). These changes were associated with longer disease duration and higher HbA1c levels (0 &lt; r \u2264 0.2, p &lt; 0.05). NODDI identified microstructural changes in white matter that were proxies for reduced neurite density and disrupted fibre orientation, correlating with disease progression and poor glucose control. In conclusion, NODDI contributed to DTI in capturing white matter differences in participants with type 2 diabetes, suggesting the feasibility of NODDI in detecting white matter alterations in type 2 diabetes. Type 2 diabetes can cause white matter microstructural abnormalities that have associations with glucose control. Conclusions: The NODDI diffusion model allows the characterisation of white matter neuroaxonal pathology in type 2 diabetes, giving biophysical information for understanding the impact of type 2 diabetes on brain microstructure. Future research should focus on the longitudinal tracking of these microstructural changes to better understand their potential as early biomarkers for cognitive decline in T2DM.<\/jats:p>","DOI":"10.3390\/medicina61030455","type":"journal-article","created":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T06:02:13Z","timestamp":1741240933000},"page":"455","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["White Matter Microstructural Alterations in Type 2 Diabetes: A Combined UK Biobank Study of Diffusion Tensor Imaging and Neurite Orientation Dispersion and Density Imaging"],"prefix":"10.3390","volume":"61","author":[{"given":"Abdulmajeed","family":"Alotaibi","sequence":"first","affiliation":[{"name":"Department of Radiological Sciences, School of Applied Medical Sciences, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh 14611, Saudi Arabia"},{"name":"Division of Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK"},{"name":"Precision Imaging Beacon, University of Nottingham, Nottingham NG7 2RD, UK"},{"name":"King Abdullah International Medical Research Center (KAIMRC), Riyadh 11481, Saudi Arabia"},{"name":"Research and Innovation Unit, College of Applied Medical Sciences, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh 14611, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mostafa","family":"Alqarras","sequence":"additional","affiliation":[{"name":"King Abdullah International Medical Research Center (KAIMRC), Riyadh 11481, Saudi Arabia"},{"name":"Research and Innovation Unit, College of Applied Medical Sciences, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh 14611, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Podlasek","sequence":"additional","affiliation":[{"name":"Division of Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK"},{"name":"Precision Imaging Beacon, University of Nottingham, Nottingham NG7 2RD, UK"},{"name":"National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Queens Medical Centre, Nottingham NG7 2UH, UK"},{"name":"Tayside Innovation MedTech Ecosystem (TIME), University of Dundee, Dundee DD1 4HN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Almanaa","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences, School of Applied Medical Sciences, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh 14611, Saudi Arabia"},{"name":"Department of Radiology and Medical Imaging, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh 11426, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2697-2927","authenticated-orcid":false,"given":"Amjad","family":"AlTokhis","sequence":"additional","affiliation":[{"name":"Division of Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK"},{"name":"Precision Imaging Beacon, University of Nottingham, Nottingham NG7 2RD, UK"},{"name":"Department of Radiological Sciences, School of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh 11564, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Aldhebaib","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences, School of Applied Medical Sciences, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh 14611, Saudi Arabia"},{"name":"King Abdullah International Medical Research Center (KAIMRC), Riyadh 11481, Saudi 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