Poorly Controlled Rheumatoid Arthritis Increases T2D Risk

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Elevated blood pressure, impaired fasting glucose, and poor EULAR-DAS28 response at 1 year follow-up is indicative of an elevated T2D risk. <i>Image credit: Biophoto Associates/Science Source</i>
Elevated blood pressure, impaired fasting glucose, and poor EULAR-DAS28 response at 1 year follow-up is indicative of an elevated T2D risk. Image credit: Biophoto Associates/Science Source

According to a study published in PLoS ONE, patients with rheumatoid arthritis (RA) have an increased short-term risk of developing type 2 diabetes (T2D).

In patients with RA, T2D remains significantly underdiagnosed and undertreated, which increases the risk of developing cardiometabolic comorbidities.

A single-center, prospective study was designed to determine the prevalence of T2D in patients with RA over the course of a year, estimating the occurrence of new T2D diagnoses while taking into consideration traditional cardiovascular and RA-specific related risk factors.

Four hundred thirty nine consecutive patients with RA were enrolled in the trial; 7.1% (31/439) developed T2D within 1 year of follow-up. 

The presence of high blood pressure (odds ratio [OR], 6.83; 95% CI, 2.18±21.34, P =.001), impaired fasting glucose (IFG) at first observation (OR, 30.55; 95% CI 6.53±142.76, P <.0001), and poor EULAR-DAS28 response at 1 year follow-up (OR, 33.59; 95% CI: 6.95±162.21, P <.0001) were all significantly associated with a higher risk of developing T2D.

After 1 year of follow-up, more than 7% (34/439) of participants had IFG, with regression analysis showing the presence of high blood pressure (OR, 5.71; 95% CI 1.40±23.27, P =.015) and poor EULAR-DAS28 response (OR, 75.22; 95% CI:23.33±242.72, P <.0001) being significantly associated with the risk of IFG (χ2 = 128.73, P <.0001).

Patients with both RA and T2D are at even higher risk for developing cardiovascular disease (CVD) and are at increased risk for CVD-related mortality. The researchers suggest that finding risk factors for T2D in patients with RA could assist in overall CVD risk reduction and management.

Limitations

  • Lack of a control group, which prevents the quantification of the relative risk of new-onset T2D and IFG compared with randomly selected patients from the general population;
  • Short follow-up period, which limits investigation of the correlation between glucose intolerance and observable cardiovascular outcomes; and
  • Lack of oral glucose tolerant test data, which results in the potential misclassification of a small subset of patients with impaired glucose tolerance as normal.

Reference

Ruscitti P, Ursini F, Cipriani P, et al. Poor clinical response in rheumatoid arthritis is the main risk factor for diabetes development in the short-term: A 1-year, single-centre, longitudinal study. PLoS ONE. 2017;12(7):e0181203.

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