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. 2023 Mar;270(3):1564-1572.
doi: 10.1007/s00415-022-11496-y. Epub 2022 Nov 27.

Onset and mortality of Parkinson's disease in relation to type II diabetes

Gianni Pezzoli  1   2 , Emanuele Cereda  3 , Paolo Amami  1   2 , Santo Colosimo  4   5 , Michela Barichella  5 , Giorgio Sacilotto  1 , Anna Zecchinelli  1 , Michela Zini  1 , Valentina Ferri  2   5 , Carlotta Bolliri  2   5 , Daniela Calandrella  1   2 , Maria Grazia Bonelli  6 , Viviana Cereda  1   2 , Elisa Reali  1   2 , Serena Caronni  2   5 , Erica Cassani  2   5   7 , Margherita Canesi  1   8 , Francesca Del Sorbo  1 , Paola Soliveri  1 , Luigi Zecca  9 , Catherine Klersy  10 , Roberto Cilia  11 , Ioannis U Isaias  12
Affiliations

Onset and mortality of Parkinson's disease in relation to type II diabetes

Gianni Pezzoli et al. J Neurol. 2023 Mar.

Abstract

Objectives: There is growing evidence that Parkinson's disease and diabetes are partially related diseases; however, the association between the two, and the impact of specific treatments, are still unclear. We evaluated the effect of T2D and antidiabetic treatment on age at PD onset and on all-cause mortality.

Research design and methods: The standardized rate of T2D was calculated for PD patients using the direct method and compared with subjects with essential tremor (ET) and the general Italian population. Age at onset and survival were also compared between patients without T2D (PD-noT2D), patients who developed T2D before PD onset (PD-preT2D) and patients who developed T2D after PD onset (PD-postT2D).

Results: We designed a retrospective and prospective study. The T2D standardized ratio of PD (N = 8380) and ET (N = 1032) patients was 3.8% and 6.1%, respectively, while in the Italian general population, the overall prevalence was 5.3%. In PD-preT2D patients, on antidiabetic treatment, the onset of PD was associated with a + 6.2 year delay (p < 0.001) while no difference was observed in PD-postT2D. Occurrence of T2D before PD onset negatively affected prognosis (adjusted hazard ratio = 1.64 [95% CI 1.33-2.02]; p < 0.001), while no effect on survival was found in PD-postT2D subjects (hazard ratio = 0.86, [95% CI 0.53-1.39]; p = 0.54).

Conclusions: T2D, treated with any antidiabetic therapy before PD, is associated with a delay in its onset. Duration of diabetes increases mortality in PD-preT2D, but not in PD-postT2D. These findings prompt further studies on antidiabetic drugs as a potential disease-modifying therapy for PD.

Keywords: Age at onset; Diabetes; Mortality; Parkinson’s disease; Prevalence.

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Conflict of interest statement

All authors have no conflict of interest to declare concerning the research related to this manuscript. GP, RC, SC, MZ, MGB, MC, FdS, PS, LZ, and EC: none. PA, MB, GS, VF, CB, DC, VC, ER, SC, EC, CK, and IUI: research grant from the Fondazione Grigioni per il Morbo di Parkinson. AZ: Advisory Board (Expert testimony) for Bial, Zambon, Italfarmaco. MC: Congress support by the International Parkinson and Movement Disorder Society (MDS) and Accademia per lo Studio della Malattia di Parkinson e i Disordini del Movimento (Accademia LIMPE-DISMOV). IUI: research grant by the German Research Foundation (DFG), the Marlene and Paolo Fresco Foundation, and Medtronic Inc. Honoraria from Medtronic Inc and Newronika Spa.

Figures

Fig. 1
Fig. 1
Flowchart of patient selection. Abbreviations: PD-noT2D PD patients without T2D, PD-preT2D patients with T2D occurrence before PD onset, PD-postT2D patients with T2D occurrence after PD onset
Fig. 2
Fig. 2
Kaplan–Meier mortality curves of PD-preT2D, PD-postT2D and PD-noT2D patients (log-rank test: χ(2) = 11.459, p < 0.003). Abbreviations: PD-noT2D PD patients without T2D, PD-preT2D patients with T2D occurrence before PD onset, PD-postT2D patients with T2D occurrence after PD onset
See this image and copyright information in PMC

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