Lu Ming-Chi, Yan Shih-Tang, Yin Wen-Yao, Koo Malcolm, Lai Ning-Sheng
Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
Division of Endocrinology and Metabolism, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
PLoS One. 2014 Jul 2;9(7):e101528. doi: 10.1371/journal.pone.0101528. eCollection 2014.
Type 2 diabetes is associated with chronic, low-grade inflammation and could potentially trigger the progression of other, more prominent inflammatory diseases such as rheumatoid arthritis (RA). Therefore, we aimed to investigate the risk of incident RA in Taiwanese patients with type 2 diabetes using a population-based health claims database.
This nationwide, population-based, case-control study used administrative data to identify 1,416 patients with RA (age ≥20 years) as cases and 7,080 controls that were frequency-matched for sex, 10-year age group, and year of catastrophic illness certificate application date (index year). All subjects were retrospectively traced back, up to 13 years prior to the index year, for their first diagnosis of type 2 diabetes. Logistic regression analysis was conducted to quantify the association between incident RA and type 2 diabetes.
The odds of developing RA were significantly higher in female (odds ratio [OR] 1.46, 95% confidence interval [95% CI] 1.24-1.72) but not in male (OR 1.00, 95% CI 0.72-1.37) patients who had previously diagnosed with type 2 diabetes. Subgroup analysis indicated that the odds of developing RA were more prominent in younger females (20 to 44 years of age) with type 2 diabetes. In addition, the odds of developing RA in female patients with type 2 diabetes were higher in those with a shorter time interval between the diagnosis of type 2 diabetes and RA.
This large nationwide, population-based, case-control study showed an elevated risk of RA in female Taiwanese patients with type 2 diabetes. Our findings were consistent with the hypothesis that chronic low-grade inflammation in type 2 diabetes may elicit the development of RA in genetically susceptible individuals.
2型糖尿病与慢性低度炎症相关，并可能引发其他更显著的炎症性疾病，如类风湿关节炎（RA）的进展。因此，我们旨在利用基于人群的健康保险理赔数据库，调查台湾2型糖尿病患者发生RA的风险。
这项全国性的、基于人群的病例对照研究使用行政数据，确定1416例RA患者（年龄≥20岁）为病例组，7080例对照组成员按性别、10岁年龄组和重大伤病证明申请日期（索引年份）进行频率匹配。所有受试者均进行回顾性追溯，直至索引年份前13年，以确定其首次2型糖尿病诊断情况。进行逻辑回归分析以量化RA发病与2型糖尿病之间的关联。
既往诊断为2型糖尿病的女性患者发生RA的几率显著更高（优势比[OR]为1.46，95%置信区间[95%CI]为1.24 - 1.72），但男性患者无显著差异（OR为1.00，95%CI为0.72 - 1.37）。亚组分析表明，2型糖尿病的年轻女性（20至44岁）发生RA的几率更为显著。此外，2型糖尿病女性患者中，2型糖尿病诊断与RA之间时间间隔较短者发生RA的几率更高。
这项大型的全国性、基于人群的病例对照研究表明，台湾2型糖尿病女性患者发生RA的风险升高。我们的研究结果与以下假设一致，即2型糖尿病中的慢性低度炎症可能在遗传易感个体中引发RA的发生。
