Abstract
Rationale: Recent literature suggests that diabetes is a risk factor for Parkinson’s disease (PD). We investigated the clinical features of idiopathic PD (IPD) patients in whom the onset of diabetes came first. Methods: We designed a case-control study. From the cohort of all new IPD patients free of vascular disease (n = 783) admitted and evaluated at our Institute over a 3-year period (2007 2010) we included all the patients with a diagnosis of diabetes prior to PD onset (n = 89) and a control group (n = 89) matched (1:1) for gender, body mass index (±1 kg/m2) and duration of PD (±1 year). The Unified PD Rating Scale (UPDRS) motor score was the primary endpoint. Results: At study entry, patients with diabetes were similar to controls in terms of most demographic, lifestyle and general medical features with exception of statins (18% vs. 3.4%; P= 0.003). However, diabetes was associated with higher UPDRS motor (22.3±9.0 vs. 19.3±7.9; P= 0.019) and activities of daily living (9.7±5.1 vs. 8.3±4.3; P= 0.049) scores, more severe Hoehn-Yahr staging (P= 0.009) and higher treatment doses of levodopa (mg/day, 448±265 vs. 300±213; P< 0.0001; mg/kg/day, 5.8±4.0 vs. 3.8±2.9; P< 0.0001). Conclusion: Onset of diabetes before the onset of PD appears to be a risk factor for more severe PD symptoms. These findings support the hypothesis that diabetes has a role in the etiopathogenesis of PD. Neurologists should be aware of the potential impact of diabetes on overall PD patient management.
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