Prevalence of type 2 diabetes and impaired fasting glucose in patients affected by rheumatoid arthritis

Abstract

Although the better management of rheumatoid arthritis (RA) has significantly improved the long-term outcome of affected patients, a significant proportion of these may develop associated comorbidities including cardiometabolic complications. However, it must be pointed out that a comprehensive cardiometabolic evaluation is still poorly integrated into the management of RA patients, due to a limited awareness of the problem, a lack of appropriate clinical studies, and optimal strategies for cardiovascular (CV) risk reduction in RA. In addition, although several studies investigated the possible association between traditional CV risk factors and RA, conflicting results are still available.On this basis, we planned this cross-sectional study, aimed at investigating the prevalence of type 2 diabetes (T2D) and impaired fasting glucose (IFG) in RA patients compared with age- and gender- matched control individuals. Furthermore, we analyzed the role of both traditional and RA-related CV risk factors in predicting T2D and IFG.We observed an increased prevalence of T2D in RA patients when compared with age- and gender-matched controls. Regression analyses demonstrated that the presence of high blood pressure (HBP), a longer disease duration, and exposure to corticosteroids (CCS) were significantly associated with an increased likelihood of being classified as T2D. In addition, we observed an increased prevalence of IFG in RA patients when compared with age- and gender-matched controls. Regression analyses demonstrated that a higher body mass index (BMI), the presence of metabolic syndrome (MetS), higher levels of total cholesterol, the presence of radiographic damage, and higher serum levels of C-reactive protein (CRP) were significantly associated with an increased likelihood of presenting IFG.In this cross-sectional study, we observed an increased prevalence of T2D and IFG in an Italian cohort of RA patients when compared with age- and gender-matched control individuals. Interestingly, both RA-specific features, such as disease duration, CCS exposure, and radiographic damage, and traditional CV risk factors, such as HBP and MetS, were significantly associated with glucose metabolism abnormalities.

Cardiovascular Safety of Anti-TNF and Non-TNF Biological Therapy in Patients with Rheumatoid Arthritis

“…Early intervention of irreversible vascular damage is strictly related to abnormal vascular tone, upregulation of fibrinolysis, and coagulation systems with subsequent procoagulant imbalance, subclinical and clinical atherosclerosis, and supporting cardiovascular disease development in RA ( Figure 2) [1,13,[18][19][20]. In addition, the link between diabetes and chronic low-grade inflammation [1][2][3] is well known, supporting the hypothesis of the interaction between traditional CV risk factors and inflammatory burden in determining diabetes in RA [1,2,13,[18][19][20].…”

“…The pathophysiology of endothelial dysfunction is multifactorial, a complex network of interacting factors and mechanisms being emphasized. Not only different metabolic (dyslipidemia, hyperglycemia), non-metabolic (hypertension, smoking, oxidative stress) but also RA-specific factors (systemic inflammation) are associated with vascular dysfunction [1,2,9,[15][16][17][18][19][20][21].…”

“…Early intervention of irreversible vascular damage is strictly related to abnormal vascular tone, upregulation of fibrinolysis, and coagulation systems with subsequent procoagulant imbalance, subclinical and clinical atherosclerosis, and supporting cardiovascular disease development in RA ( Figure 2) [1,13,[18][19][20]. In addition, the link between diabetes and chronic low-grade inflammation [1][2][3] is well known, supporting the hypothesis of the interaction between traditional CV risk factors and inflammatory burden in determining diabetes in RA [1,2,13,[18][19][20]. Furthermore, both classic risk factors (e.g., high blood pressure, high body mass index, high total cholesterol, metabolic syndrome) and novel cardiovascular risk factors (RA duration, exposure to glucocorticoids, radiographic damage, CRP levels) significantly correlated with glucose metabolism abnormalities and diabetes [1,2,13,[18][19][20].…”

Chronic Heart Failure in Rheumatoid Arthritis Patients (Part I): Prevalence, Etiology and Pathogenesis

“…Сахарный диабет. СД является хорошо известным фактором риска развития ХСН [40,41], распространенность СД 2 типа, нарушения толерантности к глюкозе и инсулинорезистентности выше у пациентов с РА по сравнению с контролем [42,43], что может способствовать увеличению риска ХСН [44].…”

Monitoring the Time Course of Disability through a Self-Assessment Instrument "Activity Index" (IA) in RA Patients

“…RA is not a single disease entity but characterized by etiologic heterogeneity and a broad spectrum of significant comorbidities, such as type 2 diabetes, cardiovascular diseases, and psychiatric disorders [3]. Ethnicity and socio-cultural factors seem to play a minor role as revealed by direct comparisons between Europe, the US and China [4,5].…”