Abstract
The purpose of this study was to assess the risk of occurrence of Parkinson's disease (PD) among subjects with type 2 diabetes and diabetic retinopathy (DR) in our large primary health care database from Catalonia (Spain). A retrospective cohort study with pseudo-anonymized routinely collected health data from SIDIAP was conducted from 2008 to 2016. We calculated the number of events, time to event, cumulative incidence, and incidence rates of PD for subjects with and without DR and for different stages of DR. The proportional hazards regression analysis was done to assess the probability of occurrence between DR and PD. In total, 26,453 type 2 diabetic subjects with DR were identified in the database, and 216,250 subjects without DR at inclusion. During the follow-up period, 1,748 PD events occurred. PD incidence rate and cumulative incidence were higher among subjects with DR (16.95 per 10,000 person-years and 0.83%, respectively). In the unadjusted analysis, subjects with DR were at 1.25 times higher risk (hazard ratio: 1.22, 95% confidence interval: 1.06; 1.41) of developing PD during the study period. However, we did not find any statistically significant HR for DR in any models after adjusting for different risk factors (age, sex, duration of diabetes, smoking, body mass index, glycosylated hemoglobin, comorbidities). In conclusion, in our primary health care population database, DR was not associated with an increased risk of PD after adjusting for different risk factors. In our retrospective cohort study, age, male sex, and diabetes duration were independent risk factors for developing PD.
Highlights
Diabetes mellitus (DM) is a metabolic disorder that may result in an unfavorable impact in different organs and leading to numerous complications [1]
DR, diabetic retinopathy; No apparent diabetic retinopathy (NDR), no apparent diabetic retinopathy; NPDR, non-proliferative diabetic retinopathy; PRD, proliferative diabetic retinopathy; DME, diabetic macular edema; ref, reference group; hazard ratios (HR), hazard ratio; 95% confidence intervals (CI), 95% confidence interval; LI, lower limit; Ul, upper limit. *Subjects having diabetic retinopathy by diagnostic code but without fundus photography/stage of DR
To date only one similar observational study with routinely collected health data from South Korea investigated the relationship between type 2 diabetes mellitus (T2DM) retinopathy and Parkinson’s disease (PD) [16]
Summary
Diabetes mellitus (DM) is a metabolic disorder that may result in an unfavorable impact in different organs and leading to numerous complications [1]. Microvascular complications affect blood microvessels, leading to complications such as diabetic peripheral neuropathy, diabetic nephropathy, and diabetic retinopathy (DR). Unlike classical vascular complications, DM may affect almost every organ system and damage other tissues or cell types [1]. It was previously reported that different neuronal damage and functional changes could occur in the retina due to poor DM control. These changes include loss of dendrites and synaptic activity, neural apoptosis, thinning of the inner retina, ganglion cell loss, reactive microglial activation, and deficits in the retina’s electrophysiological activity, dark adaptation, contrast sensitivity, or color vision [2, 3]. The complications of diabetes are far from vascular only, and there are a lot of other non-classical chronic complications of diabetes, including neurodegenerative complications [1]
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