Glucocorticoid-related levels associated with T2D risk identified in 6 immune conditions

  • Wu J & al.
  • BMJ Open Diabetes Res Care
  • 1 jul. 2020

  • de Miriam Tucker
  • Clinical Essentials
El acceso al contenido completo es sólo para profesionales sanitarios registrados. El acceso al contenido completo es sólo para profesionales sanitarios registrados.

Takeaway

  • These authors provide estimates of glucocorticoid-induced type 2 diabetes (T2D) risk for individuals with 6 immune-mediated inflammatory diseases.
  • All patients prescribed glucocorticoids should be regularly screened for diabetes.

Why this matters

  • Glucocorticoids are commonly prescribed for immune-mediated diseases but can lead to hyperglycemia and diabetes.

Study design

  • Electronic health records from UK Clinical Practice Research Datalink analyzed for 100,722 adults without diabetes history, diagnosed with:
    • Giant cell arteritis or polymyalgia rheumatica: 32.4%;
    • IBD: 29.1%;
    • Rheumatoid arthritis: 28.2%; 
    • Vasculitis: 6.0%; and 
    • Systemic lupus erythematosus: 4.4%.
  • In the prior year, 17.1% received oral, intramuscular, or intra-articular glucocorticoids and 10.2% inhaled or nasal glucocorticoids.
  • Funding: Medical Research Council.

Key results

  • Diabetes diagnosed in 8.1% over median of 4.9 years.
  • Cumulative diabetes risk at 1 year increased from 0.9% (95% CI, 0.8%-1.0%) for nonuse periods to:
    • 2.1% (95% CI, 1.9%-2.4%) for daily dose of
    • 5.0% (95% CI, 4.0%-6.0%) for ≥25.0 mg.
  • Adjusted HR for dose >0-4.9 mg was 1.90 (95% CI, 1.73-2.09), ranging from 1.28 (0.52-3.12) for vasculitis to 2.09 (1.53-2.88) for IBD. 
  • Overall HR increase per 5 mg daily dose was 1.01 (95% CI, 1.00-1.01), ranging from:
    • 1.02 (95% CI, 1.01-1.04) for polymyalgia rheumatica or giant cell arteritis, to
    • 1.23 (95% CI, 1.17-1.30) for systemic lupus erythematosus.

Limitations

  • No data on drug adherence, inpatient prescriptions.