Objective: We aimed to determine whether co-morbid type 2 diabetes mellitus (T2DM) would impact the motor or non-motor symptom severity in people with Parkinson’s (PwP).
Background: People with T2DM appear to be at increased risk of Parkinson’s disease (PD)  and there is some evidence from other studies that T2DM can worsen the motor and postural instability symptoms seen in PD . In addition, the first trial to demonstrate the possibility of a disease modifying effect for PD was using Exenatide, a GLP1 analogue used to treat T2DM .
Method: PwP were assessed as part of the East London Parkinson’s disease project case control study. For each participant we obtained basic clinical information, MDS-UPDRS scores, NMSQ and MOCA scores, and tapping data using the BRAIN test. The BRAIN test is a keyboard based tapping task that objectively measures motor impairment in PD (REFERENCE). We then compared the data for the PwP with T2DM (PwP+T2DM) and PwP who did not have a diagnosis of T2DM (PwP-T2DM). Graphpad Prism was used for all statistical analysis (two-tailed T-tests for the continuous variables). All data listed in the results are mean values and presented in the format (PwP+T2DM vs PwP-T2DM, p-value).
Results: In total we assessed 76 PwP, of which 18 (23.7%) had T2DM. The PwP+T2DM were older on average than the PwP-T2DM (72.5 vs 67.6 years, p=0.04), but had a shorter disease duration (4.5 vs 7.6 years, p=0.02). PwP+T2DM had slightly higher MDS-UPDRS part 3 scores (47.9 vs 39.8, p=0.10) but no difference in MDS-UPDRS part 4 score (3.6 vs 4.7, p=0.40). Despite this the PwP+T2DM had lower Levo-dopa equivalent doses (LEDD) (572.2 vs 725.8, p=0.18). There were no differences in NMSQ score between PwP+T2DM and PwP-T2DM (11.7 vs 12.4, p=0.71) and a negligible difference in MOCA scores (20.8 vs 23.2, p=0.14).
Conclusion: PwP and T2DM have on average a shorter disease duration but worse motor impairment compared to other PwP who do not have T2DM. There seem to be no difference in motor or cognitive symptoms although this is a relatively small sample of PwP.
References:  E. De Pablo-Fernandez, R. Goldacre, J. Pakpoor, A. J. Noyce, and T. T. Warner, “Association between diabetes and subsequent Parkinson disease,” Neurology, vol. 91, no. 2, pp. e139–e142, 2018.  E. Cereda, M. Barichella, E. Cassani, R. Caccialanza, and G. Pezzoli, “Clinical features of Parkinson disease when onset of diabetes came first: a case-control study,” Neurology, vol. 78, no. 19, pp. 1507–1511, 2012.  J. Renaud, V. Bassareo, J. Beaulieu et al., “Dopaminergic neurodegeneration in a rat model of long-term hyperglycemia: preferential degeneration of the nigrostriatal motor pathway,” Neurobiology of Aging, vol. 69, pp. 117–128, 2018.  Noyce AJ, Nagy A, Acharya S, et al., “Bradykinesia-akinesia incoordination test: validating an online keyboard test of upper limb function” PLoS One. 2014;9(4):e96260.
To cite this abstract in AMA style:A. Ben-Joseph, T. Haque, D. Gallagher, C. Budu, R. Chaudhuri, C. Simonet, A. Noyce. Type 2 diabetes mellitus may worsen severity of motor symptoms in people with Parkinson’s disease [abstract]. Mov Disord. 2020; 35 (suppl 1). https://www.mdsabstracts.org/abstract/type-2-diabetes-mellitus-may-worsen-severity-of-motor-symptoms-in-people-with-parkinsons-disease/. Accessed December 10, 2023.
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