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Observational Study
, 12 (7), e0181203
eCollection

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

Affiliations
Observational Study

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

Piero Ruscitti et al. PLoS One.

Abstract

Objectives: Despite of the European League Against Rheumatism (EULAR) provided different sets of recommendations for the management of cardiovascular risk in inflammatory arthritis patients, it must be pointed out that cardiometabolic comorbidity, such as type 2 diabetes (T2D), remains still underdiagnosed and undertreated in patients affected by rheumatoid arthritis (RA).

Methods: In this work, we designed a single centre, prospective study in order to better investigate the occurrence of T2D during the course of 1 year of follow-up. Furthermore, we evaluated the role of both traditional cardiovascular and RA-specific related risk factors to predict the occurrence of new T2D.

Results: In this study, we evaluated 439 consecutive RA patients and we observed that 7.1% of our patients (31/439) developed T2D, after 12 month of prospective follow-up. The regression analysis showed that the presence of high blood pressure, the impaired fasting glucose (IFG) at the first observation and the poor EULAR-DAS28 response, after 12 months of follow-up, were significantly associated with an increased likelihood of being classified as T2D. Similarly, we observed that 7.7% of our patients (34/439) showed IFG after 12 months of prospective follow-up. The regression analysis showed that the presence of high blood pressure and the poor EULAR-DAS28 response after 12 months of follow-up, were significantly associated with an increased likelihood of showing IFG.

Conclusions: Our study supports the hypothesis of a significant short-term risk of T2D in RA patients and of a close associations between uncontrolled disease activity and glucose metabolism derangement. Further multicentre, randomised-controlled studies are surely needed in order to elucidate these findings and to better ascertain the possible contribution of different therapeutic regimens to reduce this risk.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist for this work.

Figures

Fig 1
Fig 1. Study design.
* In the pre-recruitment screening phase, patients were excluded if presented: 1) past diagnosis of T2D previously performed by a physician or 2) current or past treatment with antidiabetic medications (including oral antidiabetic drugs and insulin); 3) fasting plasma glucose (FPG) ≥ 126 mg/dL in at least two separate occasions. ** In the recruitment screening phase patients were excluded if fasting plasma glucose (FPG) ≥ 126 mg/dL.
Fig 2
Fig 2. Receiver operator characteristic (ROC) curve of mean value DAS28(ESR) in predicting the development of type 2 diabetes (T2D).
Fig 3
Fig 3. Receiver operator characteristic (ROC) curve of mean value DAS28(ESR) in predicting the development of type 2 diabetes (T2D).

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The authors received no specific funding for this work.
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