Long-term DMARD use in RA reduces the incidence of diabetes

Long-term use of DMARDs, namely hydroxychloroquine and methotrexate (>270 days/year), is linked to reduced incidence of diabetes in RA patients, as opposed to tacrolimus, according to a nationwide population study published in Journal of Clinical Medicine.

The nested case-control study involving 69,779 diabetes-naïve adult patients with RA noted that the use of statins and a higher cumulative dose of corticosteroids were linked to an increased risk for diabetes. The use of hydroxychloroquine (OR 0.76) and methotrexate (OR 0.81) was associated with a significant reduction in diabetes. Whereas, tacrolimus (OR 1.27) was associated with an increased risk.

Diabetes mellitus has been identified as a traditional risk factor for cardiovascular disease and increased cardiovascular risk has been noted in RA patients with diabetes. Moreover, several predisposing factors namely dyslipidemia, corticosteroids, and obesity may contribute to the development of diabetes in such patients. Moreover, systemic inflammation induced by proinflammatory cytokines is also associated with insulin resistance, thereby inhibiting the insulin function at the receptor level.

Several  previous studies has attempted to find an ideal treatment regimen that can reduce the incidence of  diabetes in  RA patients.  Although some studies have reported favorable incident diabetes outcomes linked to hydroxychloroquine, there is inconsistent data to corroborate the findings. Hence, the present study findings suggesting the protective effect of conventional DMARDs on the development of incident DM hold significant relevance in developing customized treatment strategy for RA patients.

Reference: Nam SH, Kim M, Kim YJ, et al. Risk of New-Onset Diabetes Mellitus Associated with Antirheumatic Drugs in Patients with Rheumatoid Arthritis: A Nationwide Population Study. J Clin Med. 2022;11(8):2109.