Rheumatoid arthritis may increase type 2 diabetes risk
Adults with rheumatoid arthritis are 23% more likely to develop type 2 diabetes than individuals without the disease, suggesting that an inflammatory response may drive both conditions, according to findings from a meta-analysis.
“Accumulating evidence shows that inflammation emerges as a key factor in the onset and progression of diabetes,” Zixing Tian, a doctoral student in the division of diabetes, endocrinology and gastroenterology at Manchester Academic Health Science Centre, the University of Manchester, United Kingdom, told Healio. “Systemic inflammation associated with inflammatory disorders, such as rheumatoid arthritis, might contribute to the risk for developing diabetes in the future.”
Tian, Adrian Heald, MD, consultant physician in diabetes and endocrinology at Leighton and Macclesfield Hospitals and senior lecturer at the University of Manchester, U.K., and colleagues conducted a meta-analysis of five studies and two conference abstracts with 1,629,854 participants conducted through March that compared type 2 diabetes incidence among adults with rheumatoid arthritis vs. the general population. Studies were conducted in Canada (n = 2), Taiwan (n = 1), the United Kingdom (n = 2) and the United States (n = 2). All but one study were population-based. Researchers used random-effects models to calculate pooled RRs for type 2 diabetes based on rheumatoid arthritis status.
Researchers found that rheumatoid arthritis was associated with a higher risk for type 2 diabetes (pooled RR = 1.23; 95% CI, 1.07-1.4). In sensitivity analysis, excluding the one hospital-based study did not change the result.
“We confirmed an association between rheumatoid arthritis and diabetes was consistent across the five included studies,” Tian said. “However, many national guidelines for rheumatoid arthritis did not recommend assessing diabetes status and its risk factors.”
In an interview, Heald said systemic inflammation associated with rheumatoid arthritis might contribute to the risk of someone developing diabetes in the future.
“We know that all inflammatory conditions do, by their nature, increase circulating cytokine levels ... and that is going to lead into the development of type 2 diabetes as well as cardiovascular problems,” Heald said. “You may get over the acute episode of the inflammatory disorder, but there may be a level of subclinical inflammation, which results in changes in the arterial system, changes in insulin resistance and pancreatic beta-cell function.”
Additionally, rheumatoid arthritis can be associated with impaired mobility, often leading to a person reducing their physical activity, Heald said.
“It is a combination of the effect of inflammation on the processes underpinning the development of type 2 diabetes, specifically, changes in the vasculature linked with hypertension and macrovascular disease leading to insulin resistance and potentially to a degree of tiring of the beta cells, compounded with practical things like weight gain and a reduction in calorie burning,” Heald said.
Heald said providers should counsel patients with rheumatoid arthritis on healthy lifestyle and diabetes prevention.
“We want to raise awareness of this link,” Heald said. “If health care providers have someone with rheumatoid arthritis in front of them, be aware that individual is at elevated risk for developing prediabetes or type 2 diabetes in the future and the basic HbA1c screening test needs to be done, and even a lipid profile screening.”
Collapse
Tian Z, et al. Abstract #271. Presented at: EASD Annual Meeting; Sept. 21-25, 2020 (virtual meeting).
Read more about