Diabetes severity is associated with worse parkinsonism (P4.148)

OBJECTIVE: To further understand the relationship between diabetes mellitus (DM) and parkinsonism, we investigated the association between severity of DM and parkinsonian signs. BACKGROUND: There is emerging evidence that the presence of DM may increase the risk of both Parkinson’s disease (PD) and specific motor features in parkinsonism. DESIGN/METHODS: We conducted a cross-sectional study of primary care patients from the Philadelphia Healthy Brain Aging study cohort at the University of Pennsylvania. We enrolled patients over the age of 55 without PD or dementia. A modified Unified PD Rating Scale (UPDRS) was performed to assess parkinsonian signs and transformed on a scale of 0-100 for analysis. DM was defined by physician diagnosis and at least one recorded glycated hemoglobin (HbA1c). A composite diabetes severity score was created that combined the presence of retinopathy, neuropathy, nephropathy and insulin dependence. We performed regression with UPDRS score as the dependent variable and diabetes severity score as the main independent variable. Through a stepwise model, we examined confounding by demographic and clinical factors. RESULTS: Of 1100 enrolled subjects, 374 (34[percnt]) had DM at baseline. The mean age was 68.4 years (s.d. 8.6) and a little over half of the sample was female (52.9[percnt]). Median HbA1c was 6.6 (IQR 6.1-7.4) and median parkinsonian sign scores was 8.3 (IQR 2.8-25). In bivariate analysis, higher parkinsonian sign scores were associated with greater diabetes severity, older age, African-American race and a past history of arthritis. In multivariate analysis, diabetes severity remained significantly associated with higher parkinsonian sign scores (coefficient 4.24, 95[percnt] CI 0.02-8.46, p=0.05). CONCLUSIONS: This cross-sectional study shows an association between severity of DM and parkinsonian signs. Prospective studies will be useful to support the causality in this relationship and may indicate that aggressive management of DM in parkinsonian states could provide additional motor benefit. Disclosure: Dr. Dahodwala has received research support from Teva. Dr. Gold has nothing to disclose. Dr. Nwadiogbu has nothing to disclose. Dr. Fitts has nothing to disclose. Dr. Karlawish has received personal compensation in an editorial capacity for the Journal of the American Geriatrics Society.