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Type 2 Diabetes May Reduce Risk for ALS

Risk for developing amyotrophic lateral sclerosis associated with diabetes type, age of diagnosis…

Type 2 diabetes, but not type 1 diabetes, may be associated with a reduced risk for developing amyotrophic lateral sclerosis. Researchers also found that both the age of diabetes diagnosis and the age of diagnosis of amyotrophic lateral sclerosis, the neurodegenerative brain disease commonly known as ALS, affect the level of risk.

In a population-based, nested case-control study of adults living in Denmark, Marianthi-Anna Kioumourtzoglou, ScD, of the Harvard T.H. Chan School of Public Health and colleagues at other institutions analyzed data from 3,650 Danish residents diagnosed with ALS between 1982 and 2009 (46.5% women; mean age at diagnosis, 65.4 years), using data from the Danish National Patient Register to examine the association between hospital admission for diabetes and ALS diagnosis. Researchers also analyzed data from 365,000 healthy controls (100 for each ALS case) matched by age and sex. Researchers conducted the analysis in 2014.

Researchers identified 9,294 patients with diabetes at least three years before the index date (date of ALS diagnosis or same date for matched controls), 55 of whom were subsequently diagnosed with ALS. The mean age of diabetes diagnosis was 59.7 years. There was a mean of 9.8 years between diabetes diagnosis and ALS diagnosis among patients who were diagnosed with both.

Researchers found that diabetes, but not obesity, was linked to a reduced risk for ALS. When considering diabetes and obesity together, the estimated OR for ALS was 0.61 (95% CI, 0.46-0.8) for diabetes and 0.81 (95% CI, 0.57-1.16) for obesity. Researchers also found that the protective association was stronger with increasing age at ALS diagnosis (P = .01). Although the OR for first mention of diabetes was 1.66 (95% CI, 0.85-3.21) before age 40 years, it was 0.52 (95% CI, 0.39-0.7) for adults older than 40 years.

“Our findings provide some additional support on the idea that energy metabolism plays an important role in ALS pathogenesis,” Kioumourtzoglou said. “The next steps would include identification of what related to diabetes is responsible for the protective association,” Kioumourtzoglou said. “For instance, our findings suggest that it is likely type 2 diabetes is protective, while type 1 might even be a risk factor. Once the underlying mechanism is understood, then hopefully that can lead to prevention and, maybe even at some point in the future, treatment (if diabetes is found to also impact survival).”

Practice Pearls:

  • The findings provide some additional support on the idea that energy metabolism plays an important role in ALS pathogenesis.
  • Researchers found that diabetes, but not obesity, was linked to a reduced risk for ALS.
  • Researchers also found that the protective association was stronger with increasing age at ALS diagnosis.

Diabetes Mellitus, Obesity, and Diagnosis of Amyotrophic Lateral Sclerosis – A Population-Based Study. Marianthi-Anna Kioumourtzoglou
JAMA Neurol. Published online June 01, 2015. doi:10.1001/jamaneurol.2015.0910