According to a new study, statins and glucocorticoids are associated with an increased risk of diabetes in patients with rheumatoid arthritis (RA). Therefore, Michaud K, et al.examined the effect of different disease-modifying antirheumatic drugs (DMARDs) and statin treatments on diabetes risk.

Data from 13,669 patients with RA and without baseline diabetes who had been participating in the National Data Bank for Rheumatic Diseases for 1 year or more from 2000 to 2014 was studied. Follow-up continued until the participant reported diabetes diagnosis or started anti-diabetic medication.

Patients with RA were categorized into four groups, depending on DMARD and statin treatments: (1) methotrexate monotherapy; (2) abatacept with or without synthetic DMARDs; (3) any other DMARDs with methotrexate; (4) all other DMARDs without methotrexate along with the separate statin, glucocorticoid, and hydroxychloroquine. Findings were adjusted for age, sex, socioeconomic status, body mass index, comorbidities and RA severity. 

A total of 1,139 new cases of diabetes were identified during an average 4.6 years of follow-up. The standardized incidence ratio of diabetes in patients with RA (1.37) was higher than that in the general U.S. adult population. The adjusted hazard ratios for diabetes were 0.67 for hydroxychloroquine, 0.52 for abatacept (compared with methotrexate monotherapy), 1.31 for glucocorticoids and 1.56 for statins. No risk change was seen with other synthetic or biological DMARDs, nor did concomitant use of steroids alter the risk reduction with hydroxychloroquine (HR 0.69).

The researchers concluded that the incidence of diabetes mellitus was increased in RA patients. Hydroxychloroquine and abatacept were associated with decreased risk of diabetes mellitus, while glucocorticoids and statins with increased risk.