Background Rheumatoid arthritis (RA) is associated with insulin resistance (IR), a precursor to type 2 diabetes mellitus (DM). However, IR indexes are uncomfortable to examine the DM risk in clinical practice. International Diabetes Federation recommends the use of patient questionnaires to quickly identify people who may be at a higher risk of DM development.
Objectives To determine the 10-years risk of DM development in patients with RA by questionnaire Finnish Type 2 Diabetes Risk Assessment Form (FINDRISK).
Methods The study included 234 RA patients without DM (202 women, 32 men, 56 [42; 64] years old). The median disease duration was 7 [2,14] years, DAS28 was 4,73 [3,5;5,5]. The majority of pts were seropositive for IgM RF (75%) and anti-CCP (80%). RA pts were treated with glucocorticoids (43%), methotrexate (52%) or other disease-modifying antirheumatic drugs (19%), and biological agents (26%). The control group consisted of 100 subjects without inflammatory arthritis or DM, matched by age and sex with RA patients. Eight factors for FINDRISK questionnaire (increasing age, overweight, abdominal obesity, family history of diabetes, physical inactivity, eating habits, high blood pressure, history of hyperglycemia) were taken into account to calculate the total test score (TS). The risk of DM development within following 10 years is regarded as low (1%) or slightly elevated (4%) with TS ≤11 points, as moderate (17%) with TS =12–14 points, as high (33%) or very high (50%) with TS ≥15 points. Fasting glucose level was investigated in 230 RA pts after the interview.
Results The risk of DM development was low or slightly elevated in 133 (56,8%) RA pts, moderate in 51 (21,8%) pts, and high or very high in 50 (21,4%) pts. Hyperglycemia (≥6,1mmol/l) was observed in 5/131 (3,8%) pts with low or slightly elevated DM risk, 5/50 (10,0%) pts with moderate risk, and 10/49 (20,4%) pts with high or very high risk (p<0,01 for low vs high risk group). The median TS of RA pts (10 [5;14] points) was not differ from these of control subjects (11 [7;15] points). DM risk factors profile were similar in two groups, excluded more higher prevalence of unhealthy diet (51% vs 37%, p=0,02) and trend to more frequently physical inactivity (73% vs 62%, p=0,053) in RA. There were correlations between TS and fasting glucose level (r=0,38, p<0,01), HAQ (r=0,13, p=0,04), but no DAS28. Currently glucocorticoids use did not effect on TS in RA. Men had increased TS and number of risk factors compared with women with RA (13 [9;16] vs 10 [5;14] points and 5 [4;6] vs 4 [2;5] factors, p<0,01 for all cases). The number of risk factors was correlated with CRP (r=0,14, p=0,05), ESR (r=0,14, p=0,05), DAS28 (r=0,16, p=0,02) in women, but no men with rheumatic disease.
Conclusions Risk of DM development in RA pts caused by traditional risk factors as the same as in general population and partly by the presence of inflammation. Clarification of RA-specific phenomena in DM pathogenesis requires further research. FINDRISK is simple, inexpensive and effective way to identify RA pts who should be carefully observed with lifestyle change to lower their DM risk, and who need additional examination to determine if they have DM without symptoms.
Disclosure of Interest None declared