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Ann Rheum Dis doi:10.1136/ard.2011.151464
  • Clinical and epidemiological research
  • Extended report

Glucose tolerance, insulin sensitivity and β-cell function in patients with rheumatoid arthritis treated with or without low-to-medium dose glucocorticoids

  1. J W J Bijlsma1
  1. 1Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
  3. 3Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to J N Hoes, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, F02.127, PO Box 85500, 3508 GA Utrecht, The Netherlands; mail{at}hoesjn.org
  • Accepted 11 July 2011
  • Published Online First 10 September 2011

Abstract

Objectives To compare glucose tolerance and parameters of insulin sensitivity and β-cell function between chronic glucocorticoid (GC)-using and GC-naive patients with rheumatoid arthritis (RA).

Methods Frequently sampled 75 g oral glucose tolerance tests were performed in 58 chronic GC-using and 82 GC-naive patients with RA with established disease, with no known type 2 diabetes mellitus (T2DM), and 50 control subjects of comparable age with normal glucose tolerance. The associations between cumulative GC dose and disease characteristics and glucose tolerance state, insulin sensitivity and β-cell function were tested using multivariate linear and logistic regression models, correcting for patient characteristics.

Results Glucose tolerance state, insulin sensitivity and β-cell function did not differ between the two RA populations; de novo T2DM was detected in 11% and impaired glucose metabolism in 35% of patients with RA. In patients with RA, cumulative GC dose was associated with T2DM, which seemed mostly driven by the effects of cumulative GC dose on insulin resistance; however, the association decreased when corrected for current disease activity. Patients with RA had decreased insulin sensitivity and impaired β-cell function compared with controls, and multivariate regression analyses showed a negative association between the presence of RA and insulin sensitivity.

Conclusions GC-using and GC-naive patients with RA had comparable metabolic parameters, and had decreased insulin sensitivity and β-cell function as compared with healthy controls. Although cumulative GC dose was shown to have a negative impact on glucose tolerance state and insulin sensitivity, confounding by indication remains the main challenge in this cross-sectional analysis.

Footnotes

  • Funding This research was performed within the framework of project T1-106 of the Dutch Top Institute Pharma.

  • Competing interests JNH, MCvdG, DHvR, NJvdZ, DdU, WFL, JWGJ, PMJW and JWJB declared no conflicts of interest. MD disclosed advisory board membership for Abbott, Eli Lilly, Merck Sharp & Dohme, Novo Nordisk and Poxel Pharma; is consultant for Astra Zeneca/BMS, Eli Lilly, Merck Sharp & Dohme, Novo Nordisk, Sanofi Aventis; is on the speaker's bureau for Eli Lilly, Merck Sharp & Dohme, Novo Nordisk; through MD the Diabetes Center, VU University Medical Center receives all fees related to the activities mentioned above, as well as research support from Amylin Pharmaceuticals, Eli Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Takeda.

  • Ethics approval This study was conducted with the approval of the University Medical Center Utrecht.

  • Provenance and peer review Not commissioned; externally peer reviewed.