People with rheumatoid arthritis who take oral glucocorticoids have an increased risk of diabetes, the magnitude of which is dependent on dose and treatment duration, based on an analysis of two databases.
Dr. Mohammad Movahedi of the Arthritis Research UK Centre for Epidemiology at the University of Manchester (England) led researchers conducting the observational study using the U.K. primary care database (CPRD) of 21,962 RA patients and the U.S. National Data Bank for Rheumatic Diseases (NDB) involving 12,657 RA patients (Arthritis Rheumatol. 2015 Dec 14. doi: 10.1002/art.39537).
©Tashatuvango/Thinkstockphotos.com
The hazard ratio (HR) for developing diabetes was 1.30 (95% confidence interval, 1.17-1.45) for patients taking oral glucocorticoids in the CPRD cohort and 1.61 (95% CI, 1.37-1.89) for people in the NDB cohort.
While doses taken more than 6 months ago did not influence current risk, each 5-mg increase of current oral glucocorticoid dose was associated with a 25% and 30% increased risk of diabetes in the CPRD and NDB cohorts, respectively.
According to the researchers, identifying the risk of diabetes with various doses and durations of therapy allows clinicians and patients to make informed decisions about treatment as well as balance the benefits and harms.
The research team plans to examine the threshold for cost-effective diabetes screening in patients receiving steroids for RA.
Individual investigators reported support for their work from the Medical Research Council, the Canadian Institute for Health Research, the Rheumatology Research Foundation, and the NIHR Manchester Musculoskeletal Biomedical Research Unit.