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) [1] and there is some evidence from other studies that T2DM can worsen the motor and postural instability symptoms seen in PD [2]. 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 [3].

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: [1] 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. [2] 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. [3] 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. [4] 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.

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