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March 28, 2007 -- Individuals with type 2 diabetes have an increased risk for Parkinson's disease (PD) as they age, a study reports.
Gang Hu, MD, PhD, and colleagues from the National Public Health Institute in Helsinki, Finland, found that individuals who developed type 2 diabetes had an 83% increased risk for PD compared with the general population.
Although a few cross-sectional and 2 case-control studies have examined the prevalence of diabetes among patients with PD, this is the first time a large prospective study has shown that type 2 diabetes is a risk factor for PD.
"Although the association between type 2 diabetes and PD is not as great as that of coronary heart disease or stroke, this finding is still clinically important and something clinicians should pay attention to," Dr. Hu told Medscape.
The study appears in the April 2007 issue of Diabetes Care.
The prospective population-based study observed 51,552 Finnish men and women aged 25 to 74 years for a mean follow-up period of 18 years. None of the participants had a history of PD at baseline. However, 591 men and 507 women had a history of type 2 diabetes at study outset.
Compared with subjects without type 2 diabetes, individuals with diabetes were older, had higher body mass index (BMI) and systolic blood pressure (BP), had lower levels of total serum cholesterol, were less likely to smoke or drink alcohol, and were more likely to be physically inactive.
During the follow-up period, 324 men and 309 women developed incident PD. The average age of subjects at diagnosis was 64.3 years for men and 65.8 years for women.
| Hazard Ratio | 95% CI | |
|---|---|---|
| Men | 1.78 | 1.01 - 3.12 |
| Women | 1.90 | 1.04 - 3.52 |
| Overall | 1.83 | 1.21 - 2.76 |
*PD indicates Parkinson's disease; CI, confidence interval.
Source: Diabetes Care. 2007;30:842-847.
Further adjustment for BMI, systolic BP, total cholesterol, education, leisure-time physical activity, smoking, alcohol consumption, and coffee and tea consumption affected the results only slightly, the authors report.
Although the mechanism of the association between type 2 diabetes and PD is poorly understood, there are several potential possibilities, Dr. Hu noted.
For instance, according to the study, some animal and in vitro research suggests insulin may play a role in regulation of brain dopanergic activity. In addition, Dr. Hu pointed out that several lifestyle factors are associated with the risk for both type 2 diabetes and PD.
However, at this point, it is unclear whether addressing type 2 diabetes risk factors would reduce PD risk. For instance, while cigarette smoking increases the risk for type 2 diabetes, some studies have suggested there is an inverse relationship between cigarette smoking and PD risk. Caffeine also is known to reduce PD risk.
Dr. Hu also pointed out that while the Health Professionals Follow-up Study found increased physical activity was associated with a reduced risk for PD in men, this association was not found among women participating in the Nurses' Health Study.
In addition, although no association between total alcohol consumption and the risk for PD was found in either the Health Professionals Follow-up Study or the Nurses' Health Study, the combined analysis of these 2 pieces of research showed beer drinkers had a 30% lower incidence of PD than nonbeer drinkers.
However, Dr. Hu noted that in the current study individuals with type 2 diabetes were less likely to drink alcohol or smoke and were less physically active. In addition, there were no differences in coffee consumption between those with and without diabetes.
It is also possible, he added, that diabetes may increase PD risk partly through excess body weight.
Because PD mainly affects older individuals, said Dr. Hu, it is possible that lifestyle or other possible factors, such as insulin dysregulation, may need a longer period to show their effects on the dopaminergic system.
However, more research is needed to elucidate the biological mechanisms behind this association, Dr. Hu added.
The authors have disclosed no relevant financial relationships.
Diabetes Care. 2007;30:842-847.
Type 2 diabetes is associated with an excess risk for coronary artery disease and is an independent risk factor for other complications such as neurodegenerative diseases (eg, neuropathy, stroke, dementia, and Alzheimer's disease), but little is known about the association of diabetes with PD. Some studies have reported that up to half of patients with PD have abnormal glucose tolerance.
This is a cross-sectional study that is part of a longitudinal, population-based, cohort study in Finnish men and women to examine the association between type 2 diabetes and incident PD.
