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Diabetes medications and risk of Parkinson’s disease: a cohort study of patients with diabetes
Open accessAbstract
The elevated risk of Parkinson’s disease in patients with diabetes might be mitigated depending on the type of drugs prescribed to treat diabetes. Population data for risk of Parkinson’s disease in users of the newer types of drugs used in diabetes are scarce. We compared the risk of Parkinson’s disease in patients with diabetes exposed to thiazolidinediones (glitazones), glucagon-like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase 4 (DPP4) inhibitors, with the risk of Parkinson’s disease of users of any other oral glucose lowering drugs. A population-based, longitudinal, cohort study was conducted using historic primary care data from The Health Improvement Network. Patients with a diagnosis of diabetes and a minimum of two prescriptions for diabetes medications between January 2006 and January 2019 were included in our study. The primary outcome was the first recording of a diagnosis of Parkinson’s disease after the index date, identified from clinical records. We compared the risk of Parkinson’s disease in individuals treated with glitazones or DPP4 inhibitors and/or GLP-1 receptor agonists to individuals treated with other antidiabetic agents using a Cox regression with inverse probability of treatment weighting based on propensity scores. Results were analysed separately for insulin users. Among 100 288 patients [mean age 62.8 years (standard deviation 12.6)], 329 (0.3%) were diagnosed with Parkinson’s disease during the median follow-up of 3.33 years. The incidence of Parkinson’s disease was 8 per 10 000 person-years in 21 175 patients using glitazones, 5 per 10 000 person-years in 36 897 patients using DPP4 inhibitors and 4 per 10 000 person-years in 10 684 using GLP-1 mimetics, 6861 of whom were prescribed GTZ and/or DPP4 inhibitors prior to using GLP-1 mimetics. Compared with the incidence of Parkinson’s disease in the comparison group (10 per 10 000 person-years), adjusted results showed no evidence of any association between the use of glitazones and Parkinson’s disease [incidence rate ratio (IRR) 1.17; 95% confidence interval (CI) 0.76–1.63; P = 0.467], but there was strong evidence of an inverse association between use of DPP4 inhibitors and GLP-1 mimetics and the onset of Parkinson’s disease (IRR 0.64; 95% CI 0.43–0.88; P < 0.01 and IRR 0.38; 95% CI 0.17–0.60; P < 0.01, respectively). Results for insulin users were in the same direction, but the overall size of this group was small. The incidence of Parkinson’s disease in patients diagnosed with diabetes varies substantially depending on the treatment for diabetes received. The use of DPP4 inhibitors and/or GLP-1 mimetics is associated with a lower rate of Parkinson’s disease compared to the use of other oral antidiabetic drugs.
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“diabetic patients receiving GLP-1R agonists are associated with a lower risk of developing PD.”
From Microbiota–gut–brain axis and its therapeutic applications in neurodegenerative diseases (2024) · cites this paper as [615]
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Volpato, V., Menassa, D. A., Sheshadri, P., Giussani, S., Rokicki, M., Cardo, L. F., Bafaloukou, M., Schalkamp, A.-K., Zaremba, A., Monzón‐Sandoval, J., et al. (2025) · medRxiv · doi:10.1101/2025.05.28.25328401 · Cited by 2
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GLP ‐ 1RAs versus metformin and Parkinson's risk in type 2 diabetes
Sun, M., Wang, X., Lu, Z., Yang, Y., Lv, S., Miao, M., Chen, W., Wu, S., & Zhang, J. (2026) · Diabetes Obesity and Metabolism · doi:10.1111/dom.70459 · Cited by 1
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Fernández, P., Hughes, R. M., Matthews, H. F., Duffen, J., Haloub, R., Schapira, A. H. V., & Stott, S. (2026) · Journal of Parkinson s Disease · doi:10.1177/1877718x261434686 · Cited by 1
Raheel, K., Sheybani, L., Biabani, N., See, Q. R., Delogu, A., Rosenzweig, J., Cvetković, Z., Leech, R., Grossman, N., Tahmasian, M., et al. (2026) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2026.102298 · Cited by 1
Glucagon-like peptide-1 agonists in Parkinson’s disease: a meta-analysis
Abdallah, A. K., Harb, A., Mansour, A., Nasreldin, A., Hamdy, R., Hatem, N., Mosad, N., Hamouda, M., Hamouda, A., & Arumaithurai, K. (2026) · Neurological Sciences · doi:10.1007/s10072-026-09238-3 · Cited by 1
Type 2 Diabetes Mellitus and Parkinson's Disease: An Emerging Link
Teli, S., Shalavadi, M. H., Mangannavar, C. V., & Anawal, L. (2024) · Current Signal Transduction Therapy · doi:10.2174/0115743624334102241115162404 · Cited by 1
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Li, Z., Chen, X., Vong, J. S. L., Zhao, L., Huang, J., Yan, L. Y. C., Ip, B. Y. M., Wing, Y. K., Lai, H. M., Mok, V., et al. (2020) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2020.12.21.423879
Dramatic Results from an Obesity Drug May Point Toward Multiple Uses in Neurology
Robinson, R. (2021) · Neurology Today · doi:10.1097/01.nt.0000742020.38028.1d
Reply to: “ HbA1c and Motor Outcome in Parkinson's Disease in the Mark‐PD Study”
Markaki, I., Ntetsika, T., & Svenningsson, P. (2021) · Movement Disorders · doi:10.1002/mds.28676
Glucagon Like Peptide-1: More than Glucose Control and Weight ReductionPreprint
Chen, Y., Shao, S., Zhang, X., Xu, Q., & Pan, R. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4161722
Lebensstil und Parkinson-Risiko
Eschle, D. (2022) · Journal für Klinische Endokrinologie und Stoffwechsel · doi:10.1007/s41969-022-00174-z
Parkinson’s Disease - Animal Models, Current Therapies and Clinical Trials
Yenisetti, S. C., Koza, Z., Kumar, D., Singh, S. K., & Ganeshpurkar, A. (2022) · IntechOpen eBooks · doi:10.5772/intechopen.100831
Metadata
- Authors
- Brauer, R., Wei, L., Ma, T., Athauda, D., Girges, C., Vijiaratnam, N., Auld, G., Whittlesea, C., Wong, I., & Foltynie, T.
- Affiliations
- UCL School of Pharmacy (GB)
- National Hospital for Neurology and Neurosurgery (GB)
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, Queen Square, London, UK
- Corresponding author
- Wei, Li
- ORCID
- Venue
- Brain
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-10-01
- Volume
- 143
- Issue
- 10
- Pages
- 3067-3076
- ISSN
- 0006-8950 (ISSN-L)
- 1460-2156
- PMC
- PMC7794498
- OpenAlex
- W3089728969
- Cited by
- 233
- References
- 26
- Citations by year
- 2026: 31 · 2025: 56 · 2024: 45 · 2023: 33 · 2022: 38 · 2021: 27 · 2020: 3
- FWCI
- 10.93
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Brain (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- The Cure Parkinson's Trust (LW011)
- Cure Parkinson’s Trust
- Topics
- Health Sciences › Medicine › Clinical Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- Parkinson's disease, antidiabetic drugs, thiazolidinediones, GLP-1 receptor agonists, DPP-4 inhibitors, insulin, drug safety, type 2 diabetes, type 1 diabetes, Health Improvement Network, propensity score matching, inverse probability of treatment weighting, confounding by indication
- MeSH terms
- Aged, Diabetes Mellitus, Type 2, Female, United Kingdom, Humans, Hypoglycemic Agents, Longitudinal Studies, Male, Middle Aged, Parkinson Disease, Risk Factors, Cohort Studies, Glucagon-Like Peptide 1, Dipeptidyl-Peptidase IV Inhibitors
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