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Background: RA and type 2 diabetes (T2D) have common core pathophysiologic pathways, such as insulin resistance and increased glycated end products related to endothelial dysfunction, which may portendcardiovascular disease.1 Currently there is limited real-world evidence of T2D prevalence among patients (pts) with RA.
Objectives: To estimate the prevalence of T2D and insulin resistance among pts with RA vs control (osteoarthritis [OA] pts). To evaluate characteristics among RA pts with/without T2D.
Methods: A retrospective study was conducted ona subset of the JointMan database (an electronic medical record of >6000 ptsfrom >10 providers. At each visit, diagnosis, medications, test results,co-morbidities and demographic data were collected. Pts aged ≥18 years with ≥2 diagnoses of RA or satisfying ACR criteria from 1 Jan 2009 to 30 Nov 2017 were included with a control group (pts with ≥2 OA diagnoses in the same period). Pts were considered to have T2D if they had a diagnosis code, diabetic medications prescription, HbA1c ≥6.5%, random glucose test ≥200 mg/dL or prior report ofT2D. Between-group prevalence was compared using a chi-squared test and characteristics of pts with/without T2D were compared using Fisher's exact, chi-squared and Mann-Whitney tests.
Results: Data were analysed from 4181, 1157 and 1626 pts in RA-only, OA-only and dual (RA plus OA) cohorts, respectively. The RA-only cohort was younger and had a lower proportion of white pts compared with other cohorts (Table). T2D prevalence was significantly higher in the dual cohort (24.3%, n=395) vs RA-only (16.2%, n=676; p<0.001) and OA-only cohorts(10.5%, n=121; p<0.001). T2D prevalence was significantly higher in the RA-only vs OA-only cohorts (p<0.001). Sicca and Sjögren's syndromes were more prevalent co-morbidities in pts with RA only with vs without T2D (16.3 vs13.0%; p=0.023) and a similar trend was observed for thyroid disorder (6.4 vs 3.7%; p=0.001).
| RA only (n=4181) | OA only (n=1157) | Dual (RA plus OA) (n=1626) | ||||
|---|---|---|---|---|---|---|
| With T2D (n=676) | No T2D (n=3505) | With T2D (n=121) | No T2D (n=1036) | With T2D (n=395) | No T2D (n=1231) | |
| Age (years), mean (SD) | 59.6 (13.5) | 59.6 (14.8) | 68.6 (9.8) | 65.4 (11.4) | 64.7 (10.5) | 64.5 (11.1) |
| Female, n (%) | 504 (74.6) | 2643 (75.4) | 83 (68.8) | 761 (73.5) | 294 (74.4) | 943 (76.6) |
| Race, n (%) | ||||||
| American Indian or Alaska Native | 29 (4.3) | 71 (2.0) | 6 (5.0) | 9 (0.9) | 12 (3.0) | 27 (2.2) |
| White | 521 (77.1) | 2579 (73.6) | 105 (86.8) | 921 (88.9) | 363 (91.9) | 1127 (91.6) |
| Co-morbidities, n (%) | ||||||
| Sicca/Sjögren's syndromes | 110 (16.3) | 456 (13.0) | 20 (16.5) | 117 (11.3) | 92 (23.3) | 356 (28.9) |
| Thyroid disorders | 43 (6.4) | 128 (3.7) | 3 (2.5) | 65 (6.3) | 27 (6.8) | 68 (5.5) |
| Charlson Comorbidity Index, mean (SD) | 1.02 (0.15) | 1.01 (0.18) | 1.05 (0.34) | 1.01 (0.12) | 1.01 (0.14) | 1 (0.09) |
Conclusions: A higher prevalence of T2D was observed in pts with RA compared with controls. In addition, co-morbidities of Sjögren's syndrome and thyroid disorder were higher in T2D pts with RA but not for dual RA plus OA.
Reference:
Disclosure of Interest: E. AlemaoShareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, L.Ferri Employee of: Bristol-Myers Squibb, D. Paul Employee of: Bristol-Myers Squibb, A. Marshall Share holder of: Bristol-Myers Squibb, Employee of:Bristol-Myers Squibb, L. McDonald Employee of: Bristol-Myers Squibb, A. Rao Consultant for: Bristol-Myers Squibb, V. Anupindi Consultant for: Mu Sigma, G.Craig Share holder of: Discus Analytics, Grant/research support from: Bristol-Myers Squibb, Consultant for: Premera Blue Cross/Blue Shield of Washington and Alaska, Celgene, Bristol-Myers Squibb, Genentech, Novartis, Employee of: Arthritis Northwest, Paid instructor for: Washington State University Elson Floyd School of Medicine; University of Washington, Speakers bureau: Bristol-Myers Squibb, UCB, Genentech, Celgene, Novartis, Abbvie,Sanofi/Regeneron, Eli Lily, K. Knapp Shareholder of: Discus Analytics, LLC, Employee of: Discus Analytics, LLC
DOI: 10.1136/annrheumdis-2018-eular.2582