In women, type 1 diabetes associated with rheumatic disease, autoimmune conditions
Women with type 1 diabetes are nearly three times more likely to develop systemic rheumatic disease vs. men with diabetes, increasing their likelihood of developing other nonrheumatic autoimmune conditions, according to findings published in the Journal of Diabetes and Its Complications.
“Systemic rheumatic disease, including rheumatoid arthritis, scleroderma and systemic vasculitides, are debilitating conditions that disproportionately affect women,” Yicheng K. Bao, a third-year medical student at the University of Missouri-Kansas City, and colleagues from Washington University School of Medicine wrote in the study background. “Having a [systemic rheumatic disease] in addition to [type 1 diabetes] may further complicate care of both conditions, and may worsen cardiovascular and metabolic bone disease risk.”
In an observational, cross-sectional study, Bao and colleagues analyzed data from 1,212 adults with type 1 diabetes seen at the Washington University Diabetes Center between 2011 and 2018 (mean age, 47 years; 51.8% women; 89.6% white; median age at diabetes diagnosis, 18 years). Participants completed questionnaires on age at type 1 diabetes onset, concurrent systemic rheumatic diseases, and age of onset of each systemic rheumatic disease, which researchers verified via medical records. Researchers used logistic regression analysis to assess the independent effects of the presence of systemic rheumatic diseases, sex, race and age at diabetes onset on the prevalence of nonrheumatic autoimmune diseases.
Within the cohort, 6.5% had a systemic rheumatic disease, the most common being rheumatoid arthritis (4.3% of women), according to researchers. Among these patients with rheumatic disease, 63.3% had at least one nonrheumatic autoimmune disease, including hypothyroidism, hyperthyroidism and celiac disease. Adults with type 1 diabetes plus systemic rheumatic disease were nearly three times more likely to also have a nonrheumatic autoimmune condition (adjusted OR = 2.8; 95% CI, 1.71-4.6).
The researchers found that, apart from juvenile rheumatoid arthritis, the onset of systemic rheumatic disease was later than the onset of type 1 diabetes in patients with both conditions. The prevalence of systemic rheumatic disease in type 1 diabetes increased with age, ranging from 1.4% of patients aged 29 years or younger to 6.7% of patients aged 40 to 49 years and 10.7% of patients aged at least 60 years. In logistic regression analysis adjusted for sex and race, patients with type 1 diabetes aged at least 60 years were more than three times more likely to have a systemic rheumatic disease vs. patients aged 29 years or younger (OR = 3.27; 95% CI, 2.13-5.02), according to researchers.
Researchers also found that women with type 1 diabetes had a higher prevalence of systemic rheumatic disease vs. men with type 1 diabetes (9.2% vs. 3.6%; P < .0001). The difference grew wider with age, with prevalence among women aged 50 to 59 years rising to 14% vs. 3.7% in men aged 50 to 59 years. In logistic regression analysis, the OR for women developing systemic rheumatic disease vs. men was 2.71 (95% CI, 1.61-4.55), with rheumatoid arthritis and lupus being the most common conditions, according to researchers.
“The most common [systemic rheumatic disease], rheumatoid arthritis, has an age-adjusted prevalence of 0.5% in the general population, but the prevalence of [rheumatoid arthritis] is approximately fivefold higher in our study,” the researchers wrote. “This underscores the heightened risk of [systemic rheumatic diseases] in [type 1 diabetes], which increase with age and female gender.”
The researchers noted that hyperglycemia and oxidative stress from diabetes may trigger antibody binding to type II collagen, providing a causal link between the diseases. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.