Friday, August 31, 2018

Insulin resistance under-diagnosed in non-diabetics with Parkinson's disease

Very nearly 66% of non-diabetic patients with Parkinson's disease (PD) might be insulin resistant, in spite of having normal blood sugar. Researcher’s findings suggest that insulin resistance in PD is a common and largely undetected problem, especially in patients who are overweight.
Decreased glucose tolerance has long been recognized as a potential risk factor for Parkinson's disease, and there is expanding examination of insulin resistance as a pathologic driver of neurodegeneration. The key link between the two conditions appears to be insulin resistance, a potentially reversible condition that not only predisposes individuals to type 2 diabetes (DM2) but is also related with neurodegeneration. However, the prevalence of insulin resistance in Parkinson's disease is unknown.

Investigators tested 154 non-diabetic Parkinson's disease patients for fasting glucose and insulin to assess the prevalence of insulin resistance and to connect insulin resistance with other metabolic indicators, motor and non-motor symptoms of PD, and quality of life. Based a broadly used formula, known as the HOMA index, they determined how many of these patients had a reduced response to their own insulin. Among different estimations, their weight and height were recorded and their movement and cognitive performance were estimated.
Results demonstrated that almost 66% of patients had undiagnosed insulin resistance, despite normal fasting glucose and, in many cases, normal haemoglobin A1c, a test that is frequently performed for type 1 and type 2 diabetes. Their information confirmed past examinations that insulin resistance is more than double in obese compared with lean individuals, but the investigators also found a substantially higher percentage (41%) of lean Parkinson's disease patients with insulin resistance. They found no correlation between insulin resistance and cognitive decline.
The potential effect of this investigation is two-fold. Weight gain and obesity is a major public health challenge and insulin resistance appears linked to body weight. These findings could prompt to increase screening of PD patients to recognize and correct this condition.
The second and more particular impact is that identifying patients with insulin resistance could allow for personalized medicine, whereby Parkinson’s disease patients with insulin resistance may be treated with medications targeted to reverse the condition. Study on the use of diabetic medications for PD, such as GLP-1 agonists like exenatide and liraglutide, is ongoing.
Now that, for the first time, we understand how common insulin resistance is in non-diabetic patients with Parkinson’s disease, we can start to address this public health challenge. This increases the importance of finding new medications and way of life mediations that can address this metabolic dysfunction with multiple implications, from diabetes to neurodegenerative disorders like PD and Alzheimer's disease.

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Tiffany Hales
Program Manager | Diabetic 2018
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