Category: Rare Neurometabolic Movement Disorders
Objective: To explore the impact of HbA1c on imaging in Diabetic Striatopathy.
Background: Diabetic Striatopathy (DS) is a rare neurological complication of hyperglycemia. While glycemic burden is known to drive the condition, the specific correlation between HbA1c levels and imaging findings has not yet been elucidated.
Method: We performed a systematic review including studies which reported the HbA1c at presentation, with at least one imaging modality- Computed Tomography (CT) or T1-weighted Magnetic Resonance Imaging (T1W-MRI). HbA1c and clinical data were analyzed to compare CT (n=194) and T1W-MRI (n=227). Statistical significance was determined by using Mann-Whitney U and Chi-squared tests.
Results: 276 cases (117 reports) with mean age of 66.2 years; F/M = 178/98 were included. 135 cases had left sided involuntary movements (100 had right-sided imaging lesions) while 101 had right-sided symptoms (63 had left-sided imaging). 40 had bilateral symptoms, while 67 had bilateral lesions. MRI displayed a sensitivity of 85.5% vs CT (79.8%) for correct lateralization (side contralateral to side of movement). The sensitivity of MRI in identifying a lesion was 83.7% vs CT (75.8%). The lesion-present groups had a significantly higher HbA1c in all 4 paradigms- MRI (p =0.04), CT (p =0.004), CT AND MRI (concordant findings) (p 9% was significantly associated with the presence of radiological findings across CT (p =0.001, LR + =26.3), MRI (p =0.015, LR+ =5), CT AND MRI (p <0.001, LR+ =19.7), CT OR MRI (p =0.001, LR+ =10.5). HbA1c did not correlate with the time to clinical or radiological resolution, clinical lateralization, bilateral status of symptoms or imaging. Studies which also reported random blood sugar levels (n =232), had no such associations.
Conclusion: HbA1c >9% represents a critical threshold for the radiological manifestations of DS. Clinicians must therefore be aware that patients with suspected DS and HbA1c of <9% are likely to be radiologically silent. While HbA1c is predictive of the presence of radiological findings in DS, it does not influence the time to recovery. Additionally, blood sugar levels were found to have no associations with clinical or radiological parameters. T1W-MRI showed better sensitivity vs CT in identifying a lesion and in correct lateralization.
To cite this abstract in AMA style:
L. D’Souza, G. Srinivasa, K. Reddy, D. T, D. Sanjaya, S. Katti, R. Agarwal, M. Singhvi. The utility of HbA1c in Predicting Neuroimaging Findings in Diabetic Striatopathy – A Systematic Review [abstract]. Mov Disord. 2026; 41 (suppl 1). https://www.mdsabstracts.org/abstract/the-utility-of-hba1c-in-predicting-neuroimaging-findings-in-diabetic-striatopathy-a-systematic-review/. Accessed October 1, 2026.« Back to 2026 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/the-utility-of-hba1c-in-predicting-neuroimaging-findings-in-diabetic-striatopathy-a-systematic-review/