Jorge E Celedonio1, Amy C Arnold1, William D Dupont2, Claudia E Ramirez1, André Diedrich1, Luis E Okamoto1, Satish R Raj1, David Robertson1, Amanda C Peltier3, Italo Biaggioni1, Cyndya A Shibao4. 1. Division of Clinical Pharmacology, Department of Medicine, The Autonomic Dysfunction Center, Vanderbilt University School of Medicine, 562 Preston Research Building, Nashville, TN, 37232, USA. 2. Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, USA. 3. Department of Neurology, The Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, USA. 4. Division of Clinical Pharmacology, Department of Medicine, The Autonomic Dysfunction Center, Vanderbilt University School of Medicine, 562 Preston Research Building, Nashville, TN, 37232, USA. cyndya.shibao@vanderbilt.edu.
Abstract
PURPOSE: Parkinson disease, an α-synucleinopathy, is associated with reduced insulin sensitivity, impaired glucose tolerance, and diabetes mellitus. Importantly, these metabolic alterations have been shown to contribute to disease progression. The purpose of this study was to determine if reduced insulin sensitivity is also present in other α-synucleinopathies associated with autonomic failure. METHODS: We studied 19 patients with multiple system atrophy and 26 patients with pure autonomic failure. For comparison, we studied 8 healthy controls matched for body mass index. Insulin sensitivity and beta cell function were calculated using fasting glucose and insulin levels according to the homeostatic model assessment 2. A multiple linear regression model was performed to determine factors that predict insulin sensitivity in autonomic failure. RESULTS: There was a significant difference in insulin sensitivity among groups (P = 0.048). This difference was due to lower insulin sensitivity in multiple system atrophy patients: 64% [interquartile range (IQR), 43 to 117] compared to healthy controls 139% (IQR, 83 to 212), P = 0.032. The main factor that contributed to the reduced insulin sensitivity was the presence of supine hypertension and residual sympathetic tone. CONCLUSIONS: Multiple system atrophy patients have reduced insulin sensitivity that is associated with residual sympathetic activation and supine hypertension. These patients may therefore be at high risk for development of impaired glucose tolerance and diabetes mellitus.
PURPOSE:Parkinson disease, an α-synucleinopathy, is associated with reduced insulin sensitivity, impaired glucose tolerance, and diabetes mellitus. Importantly, these metabolic alterations have been shown to contribute to disease progression. The purpose of this study was to determine if reduced insulin sensitivity is also present in other α-synucleinopathies associated with autonomic failure. METHODS: We studied 19 patients with multiple system atrophy and 26 patients with pure autonomic failure. For comparison, we studied 8 healthy controls matched for body mass index. Insulin sensitivity and beta cell function were calculated using fasting glucose and insulin levels according to the homeostatic model assessment 2. A multiple linear regression model was performed to determine factors that predict insulin sensitivity in autonomic failure. RESULTS: There was a significant difference in insulin sensitivity among groups (P = 0.048). This difference was due to lower insulin sensitivity in multiple system atrophypatients: 64% [interquartile range (IQR), 43 to 117] compared to healthy controls 139% (IQR, 83 to 212), P = 0.032. The main factor that contributed to the reduced insulin sensitivity was the presence of supine hypertension and residual sympathetic tone. CONCLUSIONS:Multiple system atrophypatients have reduced insulin sensitivity that is associated with residual sympathetic activation and supine hypertension. These patients may therefore be at high risk for development of impaired glucose tolerance and diabetes mellitus.
Authors: Cyndya A Shibao; Karen Joos; John A Phillips; Joy Cogan; John H Newman; Rizwan Hamid; Jens Meiler; John Capra; Jonathan Sheehan; Francesco Vetrini; Yaping Yang; Bonnie Black; André Diedrich; David Roberston; Italo Biaggioni Journal: Neurology Date: 2021-05-04 Impact factor: 11.800
Authors: Richard J Giza; Maureen C Farrell; Amy C Arnold; Italo Biaggioni; Cyndya A Shibao Journal: Clin Auton Res Date: 2021-01-27 Impact factor: 5.625
Authors: Stuart H Isaacson; Khashayar Dashtipour; Ali A Mehdirad; Amanda C Peltier Journal: Curr Neurol Neurosci Rep Date: 2021-03-09 Impact factor: 5.081