‘Suboptimal metabolic management’ in individuals with arthritis, sort 2 diabetes


medwireNews: Patients with rheumatoid arthritis (RA) or osteoarthritis and comorbid type 2 diabetes in adults have a clinical profile of severe diabetes with poor blood sugar control, researchers report.

These results are based on an observational study of 167 people with type 2 diabetes and either RA (n = 118) or osteoarthritis (n = 49). The median age was 64 years for people with RA and 70 years for people with osteoarthritis, and approximately three-quarters of the people in both groups were women.

The researchers report in Rheumatology that people in both groups had “suboptimal metabolic control” and a “high frequency of cardiovascular risk factors”.

In particular, the average content of glycated hemoglobin (HbA1c) in people with RA was 7.0% (53 mmol / mol) and in people with osteoarthritis 7.3% (56 mmol / mol); Insulin required 27.9% and 26.5%, respectively, and the prevalence of complications (neuropathy, retinopathy, and nephropathy) ranged from 8.9% to 19.2%. The mean BMI was 27.7 and 31.8 kg / m2 in the RA and osteoarthritis groups, respectively, and 70% and 76% had hypertension, respectively.

Although both groups are “similar” [type 2 diabetes] Characteristics, ”the study’s authors state that insulin resistance correlated with age and obesity in patients with osteoarthritis, but“ with the joint and systemic inflammatory activity of the disease in patients with RA ”.

People with RA also had significantly higher levels of insulin resistance than people with osteoarthritis after adjusting for age, BMI, and corticosteroid use, with a HOMA2-IR score of 1.94 versus 1.10.

In a multivariate analysis, moderate or high RA disease activity – indicated by a DAS28 score of 3.2 points – was significantly associated with decreased insulin sensitivity, as indicated by a HOMA2-S score of less than 42 (odds ratio) [OR]= 4.46), as well as C-reactive protein levels above 10 mg / l (OR = 6.92).

“These results can have therapeutic implications, with the potential to target insulin resistance through the treatment of joint and systemic inflammation,” said Jérôme Avouac (Université de Paris, France) and co-authors.

The team also assessed the effects of RA treatment on metabolic indices, noting that the use of tumor necrosis factor inhibitors was significantly linked to insulin sensitivity but not to glycemic control, suggesting that “more prospective studies are needed to determine whether this therapeutic class may possibly improve the outcome [type 2 diabetes]. ”

Other RA treatments – including alternative biologics (tocilizumab, abatacept, and rituximab), methotrexate, hydroxychloroquine, and low-dose corticosteroids – were not significantly associated with insulin sensitivity or glycemic control.

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Rheumatology 2021; doi: 10.1093 / rheumatology / keaa810