Glucocorticoids May Increase Type 2 Diabetes Risk in Six Immune-Mediated Diseases

Findings from a recent study showed a dose-dependent association between the risk of type 2 diabetes and glucocorticoid use among patients with six common immune-mediated diseases. The study was published in BMJ Open Diabetes Research and Care.

“In immune-mediated inflammatory diseases, there is a lack of estimates of glucocorticoid dose-response diabetes risk that consider changes in prescribed dose over time and disease activity,” the researchers said. They conducted a population-based longitudinal analysis of electronic health records from the UK Clinical Practice Research Datalink and linked to the hospital admissions and mortality registry (1998-2017).
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A total of 100,722 adults without a history of diabetes who were diagnosed with giant cell arteritis or polymyalgia rheumatica (n=32,593), inflammatory bowel disease (n=29,272), rheumatoid arthritis (n=28,365), vasculitis (n=6082), or systemic lupus erythematosus (n=4410) were included (average age 58.6 years; 22.6% had body mass index [BMI] ≥30 kg/m²; 65% women). Using Cox regression methods, the researchers estimated risks and hazard ratios (HRs) of type 2 diabetes associated with time-variant daily and total cumulative prednisolone-equivalent glucocorticoid dosing.

After a median 4.9 years of follow up, 8137 patients (8.1%) developed type 2 diabetes. The researchers found that the cumulative risk of diabetes at 1 year increased from 0.9% during periods of non-use to 5.0% when the daily prednisolone-equivalent dose was greater than or equal to 25 mg. Compared with non-use, the adjusted HR for daily glucocorticoid dosing of 5 mg or less was 1.9 (95% CI, 1.44-2.50), with a range of 1.70 for rheumatoid arthritis to 2.93 for inflammatory bowel disease.

In addition, they found strong dose-dependent associations for all immune-mediated diseases, BMI levels, and underlying disease duration, even after they controlled for periods of active systemic inflammation.

“These results underline the need for regular diabetic risk assessment and testing during glucocorticoid therapy in these patients,” the researchers concluded.

Reference

Wu J, Mackie SL, Pujades-Rodriguez M. Glucocorticoid dose-dependent risk of type 2 diabetes in six immune-mediated inflammatory diseases: a population-based cohort analysis. BMJ Open Diabetes Res Care. 2020;8(1):e001220. doi:10.1136/bmjdrc-2020-001220