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Rheumatology (Oxford). 2015 Jul;54(7):1244-9. doi: 10.1093/rheumatology/keu451. Epub 2015 Jan 12.

Hydroxychloroquine reduces risk of incident diabetes mellitus in lupus patients in a dose-dependent manner: a population-based cohort study.

Author information

1
Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.
2
Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.
3
Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.
4
Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Ins

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:

diabetes; glucocorticoid; hydroxychloroquine; systemic lupus erythematosus

PMID:
25587177
DOI:
10.1093/rheumatology/keu451
[Indexed for MEDLINE]

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