Association Between Glycemic Status and the Risk of Parkinson Disease: A Nationwide Population-Based Study

Abstract

Previous studies have suggested that diabetes increases the risk of Parkinson disease (PD); however, this has not been conclusively established. We analyzed the risk of PD based on baseline glucose tolerance status in a large-scale cohort representative of the general Korean population. RESEARCH DESIGN AND METHODS This analysis was performed in a cohort of 15,168,021 adults aged ‡40 years who underwent health checkups under the National Health Insurance Service between January 2009 and December 2010. The clinical course of subjects was monitored until December 2016. Subjects were classified into the following groups: no diabetes, impaired fasting glucose (IFG), diabetes duration <5 years, and diabetes duration ‡5 years. We analyzed the adjusted hazard ratio of PD for each group. RESULTS During the observation period of 49,076,148.74 person-years, PD occurred in 31,577 patients. Compared with the nondiabetes group, the adjusted hazard ratio was 1.038 (95% CI, 1.009-1.067) in the IFG group, 1.185 (95% CI, 1.143-1.229) in the diabetes duration <5 years group, and 1.618 (95% CI, 1.566-1.672) in the diabetes duration ‡5 years group. These results were consistent with those of the subgroup analysis, and the presence of diabetes further increased the risk of PD regardless of comorbidities such as cardiovascular, cerebrovascular, and chronic kidney diseases. CONCLUSIONS This population-based cohort study suggests that diabetes is an independent risk factor for PD. The prevalence of diabetes and related complications is increasing worldwide (1,2). Accordingly, the burden on global health care related to diabetes continues to increase (1,3). Meanwhile, various therapeutic interventions for diabetes have been developed, and the clinical course and quality of life of people with diabetes have improved (4). However, it remains impossible to completely prevent the development of diabetes-related complications. Rather, the clinical significance of previously overlooked atypical complications has paradoxically increased (5). Parkinson disease (PD) is also a major chronic disease, and its clinical significance is increasing worldwide. Damage to the dopaminergic neurons of the substantia nigra is known to be a major cause of PD, which is clinically characterized by a variety of

Association Between Diabetes Medications and the Risk of Parkinson's Disease: A Systematic Review and Meta-Analysis

“…Our pooled analysis failed to demonstrate any significant association between GTZ use and the PD risk (HR, 0.88; 95% CI, 0.66 to 1.16; I 2 , 92%; p = 0.35) (Figure 4). On the sensitivity analysis, we found the study of Rhee et al (37) to exert an undue influence on the pooled effect size, and we found a statistically significant reduction in the PD risk after its exclusion (HR, 0.78; 95% CI, 0.65 to 0.93; I 2 , 59%; p = 0.05). There was no change in the significance of the results on the sequential exclusion of the remaining studies.…”

“…Twelve articles were excluded because 10 compared the PD risk between patients with and without DM and did not focus on specific DM medications (16-25) and 2 (26,27) had overlapping data with another one (28). Finally, 10 studies met the inclusion criteria and were analyzed for this review (28)(29)(30)(31)(32)(33)(34)(35)(36)(37). Table 1 presents characteristics of all included studies.…”

Effects of a DPP-4 Inhibitor and RAS Blockade on Clinical Outcomes of Patients with Diabetes and COVID-19

“…Subjects were classified according to smoking status as nonsmoker, former smoker, or current smoker. Individuals who consumed 30 g of alcohol per day were classified as being heavy alcohol consumers [ 22 , 23 ]. Regular physical activity was defined as performance of strenuous exercise for at least once per week [ 23 ].…”

Comment on Rhee et al. Association Between Glycemic Status and the Risk of Parkinson Disease: A Nationwide Population-Based Study. Diabetes Care 2020;43:2169–2175

“…Metabolic diseases, such as diabetes and obesity, increase susceptibility for additional long-term complications, including Parkinson disease (PD). Rhee et al (1) aim to address this issue by using a large data set obtained from the Korean National Health Insurance consisting of a sample of over 15 million individuals aged 40 years and older who had undergone routine checkups between 2009 and 2010. They evaluated diabetes as a risk factor for PD by analyzing how PD risk varies according to baseline glucose tolerance status, diabetes duration, and comorbidities such as obesity, cardiovascular disease, and cerebrovascular disease.…”