Abnormal Carbohydrate Metabolism in Amyotrophic Lateral Sclerosis and Parkinsonism-dementia on Guam

Abstract

Amyotrophic lateral sclerosis and Parkinsonism-dementia are unusually prevalent on Guam. Carbohydrate metabolism was studied in 110 patients with evidence diagnostic of or suspecious for these diseases. The combined incidence of known diabetes in 29 per cent of them plus a high percentage of glucose tolerance tests interpreted as abnormal, even when most age-related criteria were considered, was considerably higher than the incidence of abnormal carbohydrate metabolism reported elsewhere in the general population of the United States, the tropical Pacific area, or in recent surveys on Guam itself. The diabetes was generally mild in nature and noteworthy for a lack of retinopathy and other complications. Hypertension, hypercholesterolemia, and hyperuricemia, although highly prevalent, were not consistently associated with abnormal glucose metabolism. Similarly, no consistent association was demonstrated with such factors as age, muscle atrophy, or physical activity.

Altered Metabolic Homeostasis in Amyotrophic Lateral Sclerosis: Mechanisms of Energy Imbalance and Contribution to Disease Progression

“…However, the incidence of abnormal glucose tolerance tests in ALS patients ranges from 19-72% [9,113,115,116,117,118], and therefore subtle alterations in glucose handling could occur in ALS. Abnormal glucose metabolism does not appear to affect survival or disease severity [114,119]; however, one Taiwanese study reported an increased risk of ALS in those with DM [120].…”

Effects of diabetes mellitus on amyotrophic lateral sclerosis: a systematic review

“…The overall study size varies from 18 to 2371 participants with ALS. Diagnosis of ALS was based on EL Escorial criteria in 3 studies [7-9], on clinical criteria only in one study [10], on the combination of clinical and electromyographic (EMG) criteria in one study [11]; and it was not reported in two studies [12,13]. Likewise the diagnosis of diabetes mellitus and impaired glucose tolerance varies across studies.…”

“…Likewise the diagnosis of diabetes mellitus and impaired glucose tolerance varies across studies. Two studies used the WHO 1997 criteria [8,9], one study use the United states public health service and the national diabetes data group criteria [12], while diagnosis criteria for diabetes mellitus and dysglycemia were not provided in 3 studies.…”

“…Two cross-sectional studies reported a prevalence of IGT/DM ranging from 50 to 56% among ALS participants [10,12]. In one study, the authors reported that IGT/DM prevalence was higher in ALS compared to the general population in the same region.…”

Energy metabolism in amyotrophic lateral sclerosis: assessment of body composition and energy expenditure

“…A systematic review of seven, predominantly retrospective, observational studies found no increase in the prevalence of diabetes mellitus (DM) in ALS (Lekoubou et al, 2014), although the incidence of abnormal glucose tolerance tests in ALS patients ranges from 19% to 72% (Ionasescu and Luca, 1964, Mueller and Quick, 1970, Koerner, 1976, Harno et al, 1984, Armon et al, 1991, Pradat et al, 2010. Therefore subtle alterations in glucose handling could occur in ALS.…”