Rheumatic Diseases Affect Clinical and Biological Profile of Adult-Onset Diabetes

diabetic woman testing glucose
A mature diabetic woman checking her blood sugar levels at home.
Researchers evaluated the profile of adult-onset diabetes in patients with rheumatic diseases and identified the disease characteristics associated with insulin resistance and metabolic control.

The following article is a part of conference coverage from the American College of Rheumatology Convergence 2020, being held virtually from November 5 to 9, 2020. The team at Rheumatology Advisor will be reporting on the latest news and research conducted by leading experts in rheumatology. Check back for more from the ACR Convergence 2020.

Patients with rheumatoid arthritis (RA) and osteoarthritis (OA) with adult-onset diabetes have a clinical profile of severe type 2 diabetes (T2D), with suboptimal metabolic control, according to study results presented at the American College of Rheumatology (ACR) Convergence 2020, held virtually from November 5 to 9, 2020. In patients with RA, joint and systemic inflammation was associated with greater risk for insulin resistance.

The observational cross-sectional study included patients with T2D and OA or RA from 7 rheumatology centers in Europe. Patients were consecutively enrolled over a 24-month period. Demographic and clinical data were collected at baseline, including disease activity and severity indices, current treatment for RA and diabetes, and history of prior complications of diabetes. A blood test was conducted to assess inflammatory and metabolic parameters, including C-reactive protein (CRP) levels, fasting levels of glycemia and insulin, and hemoglobin A1C (HbA1c). Insulin resistance was assessed using the updated homeostasis model assessments for insulin secretion and tissue insulin sensitivity (HOMA2-S).

The study cohort included 122 patients with RA (mean age, 64±11 years; mean disease duration, 15±11 years) and T2D, among whom 74% were women. In addition, 54 patients with OA (knee OA, n=33; hip OA, n=21) and T2D were enrolled in the study (75% women; mean age, 68.5±11.9 years). Patients with OA vs RA had significantly greater mean body mass index (31.5±6.3 vs 27.7±5.5; P <.001). Mean HbA1c levels were 7.3% (SD, 1.29%) and 7.0% (SD, 1.19%) in the RA and OA groups, respectively, suggesting suboptimal metabolic control. Both patient groups displayed a biological profile of insulin resistance, though insulin resistance was greater among patients with RA vs OA (HOMA2-S, 69.4±31.6 vs 98.4±69.2; P =.002).

In multivariate analyses, HOMA2-S was independently associated with Disease Activity Score in 28 joints (DAS28; odds ratio [OR], 3.93; 95% CI, 1.02-15.06). Specifically, higher disease activity, according to the DAS28 score, was associated with lower tissue insulin sensitivity. While T2D metabolic control was not significantly associated with disease activity or functional impairment, HbA1c levels were independently associated with bone erosions (OR, 4.43; 95% CI, 1.18-16.61). Treatment with low-dose corticosteroids did not affect insulin sensitivity or HbA1c levels. However, compared to no treatment with biologics, treatment with tumor necrosis factor inhibitors was associated with greater insulin sensitivity (HOMA2-S, 60.0±32.5 vs 101.3±58.71; P =.001).

According to these data, patients with OA or RA experienced severe biological and clinical manifestations of adult-onset diabetes. Insulin resistance was significantly associated with joint and systemic inflammation among patients with RA.

“These findings may have therapeutic implications, with the potential targeting of insulin resistance through the treatment of joint and systemic inflammation,” the researchers concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Avouac J, Elhai M, Forien M, et al. Influence of inflammatory and non-inflammatory rheumatic disorders on the clinical and biological profile of adult-onset diabetes. Presented at: ACR Convergence 2020; November 5-9, 2020. Abstract 0192.