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Vasculitis treatment associated with increased risk for diabetes
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Compared with the general population, patients who underwent glucocorticoid treatment for systemic vasculitis had an increased risk for new-onset diabetes during initial treatment, according to results of a Danish study.
“We observed statistically significant associations between exposure to high cumulative prednisolone/PRED doses and new-onset [diabetes mellitus] DM among the patients with vasculitis. Thus, in agreement with observations made among patients with other diseases, our findings indicate that the increased risk of DM in [giant cell arteritis] GCA and [granulomatosis with polyangiitis] GPA is related to therapy with [glucocorticoid] GC in a dose-dependent manner,” Mikkel Faurschou, MD, at the Center for Rheumatology and Spine Diseases at Copenhagen University Hospital, Rigshospitalet, and colleagues wrote. “Our observations demonstrate that the therapeutic regimens used for remission induction in these vasculitic syndromes do not impose a substantial risk of late-onset DM on the treated patients.” They added, “Implementation of a screening program for DM should be considered in these patient groups.
To better determine the potential association between diabetes and forms of systemic vasculitis, Faurschou and colleagues studied patients with vasculitis and compared them with age- and sex-matched controls. They used Danish health care registries to identify medicines prescribed to patients who were diagnosed between 1997 and 2015 with GCA (n = 1,682) or GPA (n = 342). Researchers matched each patient with nine population controls. Afterward, they used Cox regression to determine diabetes risk in these patients and used logistic regression to determine diabetes risk in patients with vasculitis using the GCs prednisolone or prednisone — which had a median cumulative dose of 5.6 g or less. Mean follow-up was 6.5 years in the GCA cohort and 5.8 years in the GPA group.
Within the first year of vasculitis diagnosis, there was an increased risk for diabetes in patients with GCA (incidence rate ratio = 7) and GPA (incidence rate ratio = 10.4). There was also an increased risk for diabetes in patients with vasculitis and the use of prednisolone or prednisone (odds ratio = 1.6), as well as an increased risk for every 10-mg increase in dose (odds ratio = 1.3). In later follow-ups, the increased risk for diabetes disappeared. – by Will Offit
Disclosure: The researchers report being supported by the board of research at the Copenhagen University Hospital, Rigshospitalet.
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