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Metformin-inclusive sulfonylurea therapy reduces the risk of Parkinson's disease occurring with Type 2 diabetes in a Taiwanese population cohort.
Parkinsonism Relat Disord. 2012 Jul; 18(6):753-8.PR

Abstract

OBJECTIVES

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

Incident PD risk in T2DM increases 2.2-fold. Sulfonylureas further increase risk by 57%, which is avoided by combination with metformin.

Authors+Show Affiliations

Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli, Taiwan, ROC. profmlw@nhri.org.twNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22498320

Citation

Wahlqvist, Mark L., et al. "Metformin-inclusive Sulfonylurea Therapy Reduces the Risk of Parkinson's Disease Occurring With Type 2 Diabetes in a Taiwanese Population Cohort." Parkinsonism & Related Disorders, vol. 18, no. 6, 2012, pp. 753-8.
Wahlqvist ML, Lee MS, Hsu CC, et al. Metformin-inclusive sulfonylurea therapy reduces the risk of Parkinson's disease occurring with Type 2 diabetes in a Taiwanese population cohort. Parkinsonism Relat Disord. 2012;18(6):753-8.
Wahlqvist, M. L., Lee, M. S., Hsu, C. C., Chuang, S. Y., Lee, J. T., & Tsai, H. N. (2012). Metformin-inclusive sulfonylurea therapy reduces the risk of Parkinson's disease occurring with Type 2 diabetes in a Taiwanese population cohort. Parkinsonism & Related Disorders, 18(6), 753-8. https://doi.org/10.1016/j.parkreldis.2012.03.010
Wahlqvist ML, et al. Metformin-inclusive Sulfonylurea Therapy Reduces the Risk of Parkinson's Disease Occurring With Type 2 Diabetes in a Taiwanese Population Cohort. Parkinsonism Relat Disord. 2012;18(6):753-8. PubMed PMID: 22498320.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Metformin-inclusive sulfonylurea therapy reduces the risk of Parkinson's disease occurring with Type 2 diabetes in a Taiwanese population cohort. AU - Wahlqvist,Mark L, AU - Lee,Meei-Shyuan, AU - Hsu,Chih-Cheng, AU - Chuang,Shao-Yuan, AU - Lee,Jiunn-Tay, AU - Tsai,Hsin-Ni, Y1 - 2012/04/10/ PY - 2011/11/21/received PY - 2012/02/17/revised PY - 2012/03/15/accepted PY - 2012/4/14/entrez PY - 2012/4/14/pubmed PY - 2012/10/24/medline SP - 753 EP - 8 JF - Parkinsonism & related disorders JO - Parkinsonism Relat Disord VL - 18 IS - 6 N2 - OBJECTIVES: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: Incident PD risk in T2DM increases 2.2-fold. Sulfonylureas further increase risk by 57%, which is avoided by combination with metformin. SN - 1873-5126 UR - https://www.unboundmedicine.com/medline/citation/22498320/Metformin_inclusive_sulfonylurea_therapy_reduces_the_risk_of_Parkinson's_disease_occurring_with_Type_2_diabetes_in_a_Taiwanese_population_cohort_ DB - PRIME DP - Unbound Medicine ER -