Study Suggests Diabetes Risk with Common RA Medication

A study conducted by University of Manchester researchers has determined how the risk of diabetes increases in connection to the dosage, duration, and timing of glucocorticoid (GC) therapy, which is prescribed to roughly half of patients with rheumatoid arthritis (RA).

In an effort to quantify the risk of incident diabetes mellitus associated with this commonly used treatment, the investigators undertook a cohort study using 2 databases: The Clinical Practice Research Datalink (CPRD), a United Kingdom primary care database including 21,962 RA patients; and the US National Data Bank for Rheumatic Disease (NDB), which encompassed 12,657 RA patients.
_______________________________________________________________________________________________________________________________________________________________________

Information on the dosage and timing of GC use was extracted, and diabetes mellitus in the CPRD was defined using Read codes, at least 2 prescriptions for oral antidiabetic medication, or abnormal blood test results. Diabetes mellitus in the NDB was defined through patient self-reports. The authors note that data were analyzed using time-dependent Cox models and a novel weighted cumulative dose model that accounts for dosage, duration, and timing of treatment.

Ultimately, the researchers found that glucocorticoids were linked to 1 new case of diabetes for every 150 to 200 people treated per year. Within this group, however, risk was impacted by the dose only in the most recent 6 months, according to the investigators, who note that each increase of 5 mg prednisolone per day equated to a 25% to 30% increase in diabetes. A dose of less than 5 mg was not connected to a measurable risk of diabetes in comparison to no treatment.

Ultimately, the key message that these findings hold for primary care practitioners is "that the risk of diabetes is now quantified for any pattern of steroid use," says lead study author Will Dixon, PhD, BSc, MSc, director of the Arthritis Research UK Centre for Epidemiology at the University of Manchester.

Dixon adds that 5 mg prednisolone or less "looks to be low-risk for developing diabetes," while noting that "the risk of diabetes is only influenced by steroids taken within the last 6 months."

—Mark McGraw

Reference

Movahedi M, Beauchamp ME, Abrahamowicz M, et al. Risk of incident diabetes associated with dose and duration of oral glucocorticoid therapy in patients with rheumatoid arthritis. Arthritis & Rheumatology. 2016;68(5):1089-98.