The incidence of type 2 diabetes mellitus and the traditional risk factors of carbohydrate metabolic disorders in patients with rheumatoid arthritis

Objective: to clarify the primary incidence of type 2 diabetes mellitus (DM) in patients with rheumatoid arthritis (RA) and to compare the prevalence of traditional risk factors (RFs) in groups of patients with and without carbohydrate metabolic disorders.

Patients and methods. A retrospective analysis was carried out in 158 patients with RA (diagnosed at the age of 45 years and older; the disease duration was more than 12 months). The exclusion criteria were concomitant type 1 DM and type 2 DM that was diagnosed before or at the onset of RA. The patients' median age was 62 [57; 68] years. Most RA patients had moderate (41.8%) and high (39.9%) DAS28. New cases of type 2 DM and the presence of hyperglycemia were recorded at the time of the examination. The traditional RFs of type 2 DM were assessed using the Finnish Diabetes Risk Score (FINDRISC).

Results and discussion. The incidence rates of type 2 DM was 9.3 per 1000 patient-years. The patients with developed type 2 DM versus those without DM had a larger number of RFs according to the the FINDRISC questionnaire (6 [5; 7] and 5 [4; 5]; p<0.01), had more frequently experienced myocardial infarction and undergone surgery for myocardial revascularization (27.3 and 2.7%; p<0.01), taken beta-adrenoblockers (72.7 and 33.3%; p<0.05) and calcium channel blockers (36.4 and 12.2%; p<0.05). Fasting hyperglycemia was detected in 10.1% of RA patients. The patients with hyperglycemia versus those with normal venous blood glucose levels more often had obesity (50.0 and 29.8%) and a history of hyperglycemic episodes (43.8 and 19.1%) and less frequently used glucocorticoids (18.8 and 47.3%; p<0.05 for all cases). Conclusion. The high incidence of type 2 DM in RA was associated with the presence of a set of traditional RFs and previous cardiovascular disease, while fasting hyperglycemia was with individual RFs for carbohydrate metabolic disorders. 

1. Rheumatology. Clinical guidelines]. Moscow: GEOTAR-Media; 2017. 464 p.

2. Pappas DA, Nyberg F, Kremer JM, et al. Prevalence of cardiovascular disease and major risk factors in patients with rheumatoid arthritis: a multinational cross-sectional study. Clin Rheumatol. 2018 Sep;37(9):2331-2340. doi: 10.1007/s10067-018-4113-3.

3. Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/ European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010;69(9): 1580-8. doi: 10.1136/ard.2010.138461

4. Lindstrom J, Tuomilehto J. The diabetes risk score: a practical tool to predict type 2 diabetes risk. Diabetes Care. 2003 Mar; 26(3):725-31.

5. Dedov II, Shestakova MV, Aleksandrov AA, et al. Algorithms of specialized medical care for diabetes mellitus patients. Diabetes mellitus. 2011;(3s):2–72. (In Russ.). doi:10.14341/2072-0351-5612.

6. Jiang P, Li H, Li X. Diabetes mellitus risk factors in rheumatoid arthritis: a systematic review and meta-analysis. Clin Exp Rheumatol. 2015 Jan-Feb;33(1):115-21. Epub 2014 Dec 22.

7. Dessein PH, Joffe BI. Insulin resistance and impaired beta-cell function in rheumatoid arthritis. Arthritis Rheum. 2006;54(9): 2765-75. doi:10.1002/art.22053.

8. Chung CP, Oeser A, Solus JF, et al. Inflammation-associated insulin resistance: differential effects in rheumatoid arthritis and systemic lupus erythematosus define potential mechanisms. Arthritis Rheum. 2008;58(7): 2105-12. doi:10.1002/art.23600.

9. Dedov II, Shestakova MV, Vikulova OK, et al. Diabetes mellitus in Russian Federation: prevalence, morbidity, mortality, parameters of glycaemic control and structure of glucose loweringtherapy according to the federal diabetes register, status 2017. Diabetes Mellitus. 2018; 21(3):144-59. (In Russ.). doi: 10.14341/DM9686

10. Solomon DH, Love TJ, Canning C, Schneeweiss S. Risk of diabetes among patients with rheumatoid arthritis, psoriatic arthritis and psoriasis. Ann Rheum Dis. 2010 Dec;69(12):2114-7. doi: 10.1136/ard.2009.125476.

11. Dubreuil M, Rho YH, Man A, et al. Diabetes incidence in psoriatic arthritis, psoriasis and rheumatoid arthritis: a UK population-based cohort study. Rheumatology (Oxford). 2014 Feb;53(2):346-52. doi: 10.1093/rheumatology/ket343.

12. Ruscitti P, Ursini F, Cipriani P, et al. Poor clinical response in rheumatoid arthritis is the main risk factor for diabetes development in the short-term: A 1-year, single-centre, longitudinal study. PLoS One. 2017 Jul 12;12(7): e0181203. doi: 10.1371/journal.pone.0181203. eCollection 2017.

13. Wilson PW, D’Agostino RB, Parise H, et al. Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation. 2005 Nov 15;112(20): 3066-72. Epub 2005 Nov 7. doi: 10.1161/CIRCULATIONAHA.105.539528.