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. 2021 Feb 19;10(2):125-131.
doi: 10.1097/XCE.0000000000000244. eCollection 2021 Jun.

The relationship between rheumatoid arthritis and diabetes mellitus: a systematic review and meta-analysis

Zixing Tian  1 , John Mclaughlin  1 , Arpana Verma  2 , Hector Chinoy  3   4   5 , Adrian H Heald  1   1
Affiliations

The relationship between rheumatoid arthritis and diabetes mellitus: a systematic review and meta-analysis

Zixing Tian et al. Cardiovasc Endocrinol Metab. .

Abstract

Objective: This systematic review/meta-analysis was conducted to investigate the relationship between rheumatoid arthritis and the incidence of diabetes mellitus.

Methods: A comprehensive search was conducted up to 10 March 2020 in Medline (via Ovid), Embase (via Ovid) and Web of Science core collection to identify cohort studies comparing the risk of diabetes mellitus incidence in people with rheumatoid arthritis with the general population. The I2 statistic was used to test heterogeneity. Pooled relative risks were calculated using random-effects models. Publication bias was assessed using Egger's test and Begg's test.

Results: The initial search provided 3669 articles. Of those, five journal articles/two conference abstracts comprising 1 629 854 participants were included in this study. The funnel plot showed potential publication bias, proven by Egger's test (-3.15, P < 0.01), but not Begg's test (-0.05, P = 1.00). Heterogeneity was observed in I2 test (I2 = 96%, P < 0.01). We found that rheumatoid arthritis was associated with a higher risk of diabetes mellitus incidence (pooled relative risk, 1.23; 95% confidence interval, 1.07-1.40). Exploration of potential sources of heterogeneity found significant heterogeneity in different countries/regions (P = 0.002), but heterogeneity was NS in different study designs (P = 0.30). Sensitivity analyses confirmed that the association between rheumatoid arthritis and diabetes mellitus incidence was robust.

Conclusion: Rheumatoid arthritis is associated with an increased risk of diabetes mellitus incidence. This finding supports the notion that inflammatory pathways are involved in the pathogenesis of diabetes. More intensive interventions targeting diabetes risk factors should be considered in people with rheumatoid arthritis.

Keywords: diabetes mellitus; incidence; inflammation; meta-analysis; rheumatoid arthritis.

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Conflict of interest statement

Z.T. is supported by China Scholarship Council. H.C. is supported by the National Institute for Health Research Biomedical Research Centre Funding Scheme. For the remaining authors, there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart of study selection. RA, rheumatoid arthritis.
Fig. 2
Fig. 2
Incidence of diabetes in people with rheumatoid arthritis compared with controls, calculated from a 2 × 2 table. RA, rheumatoid arthritis; CI, confidence interval; M–H random, Mantel–Haenszel random
Fig. 3
Fig. 3
Incidence of diabetes in people with rheumatoid arthritis compared with controls, generic inverse variance method. RA, rheumatoid arthritis; CI, confidence interval; M–H random, Mantel–Haenszel random.
Fig. 4
Fig. 4
Publication bias in meta-analysis with funnel plot.
See this image and copyright information in PMC

References

    1. Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010; 376:1094–1108. - PubMed
    1. Batko B, Stajszczyk M, Swierkot J, Raciborski F, Wiland P. Prevalence and clinical characteristics of rheumatoid arthritis in Poland: first nationwide study. Arthritis and Rheumatology Conference: American College of Rheumatology/Association of Rheumatology Health Professionals Annual Scientific Meeting, ACR/ARHP; 2015; vol 67 (Suppl 10).
    1. Donath MY, Dalmas É, Sauter NS, Böni-Schnetzler M. Inflammation in obesity and diabetes: islet dysfunction and therapeutic opportunity. Cell Metab. 2013; 17:860–872. - PubMed
    1. Blum A, Adawi M. Rheumatoid arthritis (RA) and cardiovascular disease. Autoimmun Rev. 2019; 18:679–690. - PubMed
    1. Chung CP, Oeser A, Solus JF, Avalos I, Gebretsadik T, Shintani A, et al. . Prevalence of the metabolic syndrome is increased in rheumatoid arthritis and is associated with coronary atherosclerosis. Atherosclerosis. 2008; 196:756–763. - PubMed