Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli, Taiwan, ROC.
Parkinsonism Relat Disord. 2012 Jul;18(6):753-8. doi: 10.1016/j.parkreldis.2012.03.010. Epub 2012 Apr 10.
Type 2 diabetes (T2DM) may increase the risk of Parkinson's disease (PD). We evaluated the role of oral anti-hyperglycemic agents (OAA) in any diabetes-PD linkage.
From the Taiwan National Health Insurance database on 01-01-2000, a representative cohort of 800,000 was obtained between 1996-01-01 and 2007-12-31. Those ≥ 20 years were classified by presence (n = 64,166) or absence (n = 698,587) of T2DM, and whether any OAA (n = 41,003) or not (n = 23,163) was used. Those with T2DM were matched with those diabetes-free by birth-date and gender for the comparison of PD incidence. We considered those ≥ 50 years and matched PD-free diabetes patients with and without OAAs by age, gender, locality, health service, Charlson comorbidity index and T2DM diagnosis-date to avoid 'immortal time bias'. PD incidence densities (PID, per 10,000 person-years) and hazard ratios (HRs) were calculated.
HRs (95% confidence interval, CI), related to diabetes-free, were 2.18 (1.27-3.73) and 1.30 (0.77-2.19) for T2DM without and with OAAs. For sulfonylurea alone, PID (95% CI) increased from 58.3 (46.6-70.1) to 83.2 (68.6-97.7), with similar findings by gender, but little difference if metformin was used. The metformin-alone HR (95% CI) was 0.95 (0.53-1.71), sulfonylurea-alone 1.57 (1.15-2.13), and combined therapy 0.78 (0.61-1.01) and these differences persisted when incident PD was excluded for 4 years after T2DM diagnosis. The use of metformin first, in those without insulin, provided an HR of 0.40 (0.17-0.94).
Incident PD risk in T2DM increases 2.2-fold. Sulfonylureas further increase risk by 57%, which is avoided by combination with metformin.
2 型糖尿病（T2DM）可能会增加帕金森病（PD）的风险。我们评估了口服降糖药（OAA）在任何糖尿病-PD 关联中的作用。
我们从台湾全民健康保险数据库中获得了 2000 年 1 月 1 日至 2007 年 12 月 31 日之间的一个代表性队列，该队列的 1996 年 1 月 1 日至 2007 年 12 月 31 日之间的 800,000 人。年龄在 20 岁以上的人群根据是否存在（n = 64,166）或不存在（n = 698,587）T2DM，以及是否使用任何 OAA（n = 41,003）或未使用（n = 23,163）进行分类。那些患有 T2DM 的人根据出生日期和性别与无糖尿病的人进行匹配，以比较 PD 的发病率。我们考虑了年龄在 50 岁以上的人群，并根据年龄、性别、地区、医疗服务、Charlson 合并症指数和 T2DM 诊断日期，将无 OAAs 的匹配 PD 糖尿病患者与有 OAAs 的患者进行了匹配，以避免“不朽时间偏倚”。计算了 PD 发病率密度（PID，每 10,000 人年）和风险比（HR）。
与无糖尿病者相比，HR（95%置信区间，CI）为 2.18（1.27-3.73）和 1.30（0.77-2.19），分别为无 OAA 和有 OAA 的 T2DM。对于单独使用磺酰脲类药物，PID（95%CI）从 58.3（46.6-70.1）增加到 83.2（68.6-97.7），性别之间存在类似的发现，但如果使用二甲双胍则差异不大。单独使用二甲双胍的 HR（95%CI）为 0.95（0.53-1.71），磺酰脲类药物为 1.57（1.15-2.13），联合治疗为 0.78（0.61-1.01），这些差异在 T2DM 诊断后 4 年内排除新发 PD 后仍然存在。对于那些没有胰岛素的人，首先使用二甲双胍的 HR 为 0.40（0.17-0.94）。
T2DM 患者的 PD 发病风险增加了 2.2 倍。磺酰脲类药物进一步增加了 57%的风险，这可以通过与二甲双胍联合使用来避免。
