Rheumatoid Arthritis (RA) and Diabetes
Understanding the RA/diabetes connection.
RA/Diabetes Connection: Can the Risk Be Lowered? continued...
In one study, people with RA who had ever taken hydroxychloroquine were 53% less likely to develop diabetes than their counterparts who had never taken it. In another study of patients with RA, researchers found that having ever taken hydroxychloroquine reduced the risk of diabetes by 38%. What’s more, people with RA who took hydroxychloroquine for more than four years were 77% less likely to report a new diabetes diagnosis than those who never took it.
“This is a safe and inexpensive drug and it has been consistently shown to decrease the risk of diabetes in RA,” says Bili, the author of the first study.
RA/Diabetes Connection: Making Informed Choices to Reduce the Risk
Does the effectiveness of hydroxychloroquine in reducing diabetes risk mean all people with RA and risk factors for diabetes should take it?
“It is a reasonable choice,” Bili says, “but it is a weaker treatment for RA. It may not achieve disease control.” Other drugs are more effective when it comes to treating the pain and inflammation of RA. “But, says Bili, “for people with mild RA who have risk factors for diabetes, it might be reasonable to start treatment with hydroxychloroquine. If they have more severe RA, she tells WebMD, hydroxychloroquine could be taken in combination with another arthritis drug.
It’s not clear why hydroxychloroquine is associated with lower diabetes risk among people with RA. It may allow the hormone insulin to remain in the body longer. This could improve insulin sensitivity and glucose tolerance and prevent diabetes.
Solomon says that what is known now is that insulin resistance is elevated in RA, but certain RA drugs such as TNF blockers, hydroxychloroquine, and methotrexate may improve insulin sensitivity. "Studies show that TNF antagonists taken for a month or a year improve insulin resistance,” Solomon says. "But we don't know if this will lead to reduced diabetes risk."
Many important questions remain about the link between diabetes and arthritis. "We don't know whether tighter control of RA will reduce the risk of diabetes," Solomon says. A study that looks at the effect of better RA control in reducing the risk of diabetes would, he says, “be a wonderful trial."
In the meantime, it’s important to keep in mind that making healthy lifestyle choices involving exercise, diet, and not smoking is an important part of RA management. And those same choices are important in managing the risk of diabetes.