Yi-Ming Chen1, Ching-Heng Lin2, Tsuo-Hung Lan3, Hsin-Hua Chen3, Shih-Ni Chang2, Yi-Hsing Chen3, Jun-Sing Wang3, Wei-Ting Hung3, Joung-Liang Lan3, Der-Yuan Chen4. 1. Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan. 2. Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan. 3. Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan. 4. Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Ins
Abstract
OBJECTIVE: SLE is associated with increased risk of diabetes mellitus. Treatment for SLE requires high-dose glucocorticoids that may worsen glucose homoeostasis. HCQ can reduce diabetes risk in RA. This study aimed to investigate the association of HCQ use and diabetes mellitus risk in SLE patients. METHODS: This nationwide, population-based cohort study was conducted using the Taiwan National Health Insurance Research Database. In the period 2001-10, 8628 newly diagnosed SLE patients were identified after excluding those with a previous diagnosis of RA, psoriasis or diabetes mellitus. Incidence of diabetes mellitus was identified as a new diagnostic code using a diabetes mellitus-specific medication. RESULTS: Two hundred and twenty-one newly diagnosed diabetes mellitus patients were identified among SLE patients (6795 had taken HCQ and 1833 had never taken HCQ), with an average follow-up period of 5.6 years. Compared with patients without HCQ treatment, the hazard ratio (HR) of diabetes mellitus in patients taking HCQ at a cumulative dose ≥129 g was reduced [HR 0.26 (95% CI 0.18, 0.37), P < 0.001]. Daily glucocorticoid ≥10 mg prednisolone-equivalent dose was associated with increased risk of developing diabetes mellitus [HR 2.47 (95% CI 1.44, 4.23), P = 0.001], which was minimized by concomitant HCQ use at a cumulative dose ≥129 g. CONCLUSION: In SLE patients, the use of HCQ is associated with reduced risk of incident diabetes mellitus in a dose-dependent manner. High-dose glucocorticoids increase the risk of diabetes, which can be decreased by concomitant HCQ use.
OBJECTIVE:SLE is associated with increased risk of diabetes mellitus. Treatment for SLE requires high-dose glucocorticoids that may worsen glucose homoeostasis. HCQ can reduce diabetes risk in RA. This study aimed to investigate the association of HCQ use and diabetes mellitus risk in SLEpatients. METHODS: This nationwide, population-based cohort study was conducted using the Taiwan National Health Insurance Research Database. In the period 2001-10, 8628 newly diagnosed SLEpatients were identified after excluding those with a previous diagnosis of RA, psoriasis or diabetes mellitus. Incidence of diabetes mellitus was identified as a new diagnostic code using a diabetes mellitus-specific medication. RESULTS: Two hundred and twenty-one newly diagnosed diabetes mellituspatients were identified among SLEpatients (6795 had taken HCQ and 1833 had never taken HCQ), with an average follow-up period of 5.6 years. Compared with patients without HCQ treatment, the hazard ratio (HR) of diabetes mellitus in patients taking HCQ at a cumulative dose ≥129 g was reduced [HR 0.26 (95% CI 0.18, 0.37), P < 0.001]. Daily glucocorticoid ≥10 mg prednisolone-equivalent dose was associated with increased risk of developing diabetes mellitus [HR 2.47 (95% CI 1.44, 4.23), P = 0.001], which was minimized by concomitant HCQ use at a cumulative dose ≥129 g. CONCLUSION: In SLEpatients, the use of HCQ is associated with reduced risk of incident diabetes mellitus in a dose-dependent manner. High-dose glucocorticoids increase the risk of diabetes, which can be decreased by concomitant HCQ use.
Authors: Scott J Pilla; Amy Q Quan; Emily L Germain-Lee; David B Hellmann; Nestoras N Mathioudakis Journal: Curr Diab Rep Date: 2016-10 Impact factor: 4.810
Authors: April Jorge; Na Lu; Hyon Choi; John M Esdaile; Diane Lacaille; J Antonio Avina-Zubieta Journal: Arthritis Care Res (Hoboken) Date: 2021-12-23 Impact factor: 5.178
Authors: Fabiana B Benatti; Cíntia N H Miyake; Wagner S Dantas; Vanessa O Zambelli; Samuel K Shinjo; Rosa M R Pereira; Maria Elizabeth R Silva; Ana Lúcia Sá-Pinto; Eduardo Borba; Eloisa Bonfá; Bruno Gualano Journal: Front Immunol Date: 2018-04-27 Impact factor: 7.561