Hydroxychloroquine reduces risk of incident diabetes mellitus in lupus patients in a dose-dependent manner: a population-based cohort study
Open Access
- 12 January 2015
- journal article
- research article
- Published by Oxford University Press (OUP) in Rheumatology
- Vol. 54 (7), 1244-1249
- https://doi.org/10.1093/rheumatology/keu451
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.Keywords
This publication has 20 references indexed in Scilit:
- Association Between Disease-Modifying Antirheumatic Drugs and Diabetes Risk in Patients With Rheumatoid Arthritis and PsoriasisJAMA, 2011
- Changes in glycosylated hemoglobin after initiation of hydroxychloroquine or methotrexate treatment in diabetes patients with rheumatic diseasesArthritis & Rheumatism, 2010
- Risk of diabetes among patients with rheumatoid arthritis, psoriatic arthritis and psoriasisAnnals Of The Rheumatic Diseases, 2010
- Hydroxychloroquine and Glycemia in Women with Rheumatoid Arthritis and Systemic Lupus ErythematosusThe Journal of Rheumatology, 2010
- Inflammation‐associated insulin resistance: Differential effects in rheumatoid arthritis and systemic lupus erythematosus define potential mechanismsArthritis & Rheumatism, 2008
- Hypoglycaemia induced by hydroxychloroquine in a non-diabetic patient treated for RARheumatology, 2007
- ‘Not only…but also’: factors that contribute to accelerated atherosclerosis and premature coronary heart disease in systemic lupus erythematosusRheumatology, 2005
- Prevalence and Correlates of Accelerated Atherosclerosis in Systemic Lupus ErythematosusThe New England Journal of Medicine, 2003
- Risk factors for coronary heart disease in women with systemic lupus erythematosus: The Toronto Risk Factor StudyArthritis & Rheumatism, 2003
- The effectiveness of hydroxychloroquine in patients with type 2 diabetes mellitus who are refractory to sulfonylureas—a randomized trialDiabetes Research and Clinical Practice, 2002