title: ALS disease onset may occur later in patients with pre-morbid diabetes mellitus.
abstract: BACKGROUND
  Several metabolic derangements associated with diabetes mellitus type 2 (DM) have been associated with a better outcome in amyotrophic lateral sclerosis (ALS), including hyperlipidemia and obesity. Here, we tested the hypothesis that DM would have a positive effect on the motor and cognitive findings of ALS.
  
  
  METHODS
  We compared data from ALS patients with pre-morbid DM (ALS-DM; n = 175) versus without DM (ALS; n = 2196) with regard to the age of onset, rate of motor progression, survival, and neuropsychological test performance.
  
  
  RESULTS
  The age of onset was later for women, Caucasians and patients with bulbar-onset ALS. However, we also found that after adjusting for gender, ethnicity and site of onset, DM was associated with a 4-year later onset of ALS (ALS = 56.3, ALS-DM = 60.3, P < 0.05).
  
  
  CONCLUSIONS
  Diabetes mellitus type 2 may delay the onset of motor symptoms in ALS. These findings support other studies suggesting a relationship between the pathophysiology of ALS and metabolic derangements. Further investigations are needed to ascertain whether manipulating metabolic parameters would improve outcomes in ALS.
authors.affiliation: Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA.
authors.forename: A
authors.initials: A
authors.lastname: Jawaid
authors.forename: A R
authors.initials: AR
authors.lastname: Salamone
authors.forename: A M
authors.initials: AM
authors.lastname: Strutt
authors.forename: S B
authors.initials: SB
authors.lastname: Murthy
authors.forename: M
authors.initials: M
authors.lastname: Wheaton
authors.forename: E J
authors.initials: EJ
authors.lastname: McDowell
authors.forename: E
authors.initials: E
authors.lastname: Simpson
authors.forename: S H
authors.initials: SH
authors.lastname: Appel
authors.forename: M K
authors.initials: MK
authors.lastname: York
authors.forename: P E
authors.initials: PE
authors.lastname: Schulz
mesh_terms: D017668:Age of Onset; D000690:Amyotrophic Lateral Sclerosis / Q000453:epidemiology* / Q000209:etiology; D003072:Cognition Disorders / Q000150:complications / Q000453:epidemiology; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D015996:Survival Rate