Outcomes after ischemic stroke for hospitals with and without Joint Commission–certified primary stroke centers

among newly diagnosed patients with PD and diabetes compared to nondiabetic patients (20.2% in H&Y stage 3 vs 4.5%). These findings suggest that postural instability and gait difficulty (PIGD) may be the primary clinical factor driving increased motor burden among diabetic patients. PIGD is less dopamine-responsive than bradykinesia or rigidity and is closely tied to H&Y scoring. Axial motor impairment in PD is likely worsened by many nondopaminergic factors including white matter burden,2 polyneuropathy, and other diabetes-related medical comorbidities. Diabetes may represent a risk factor for disease burden in PD, albeit one that is more closely related to extranigral pathology unlikely to improve with escalating doses of levodopa.