Epidemiology, German Rheumatism Research Centre, Berlin, Germany.
Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Germany.
Rheumatology (Oxford). 2018 Feb 1;57(2):329-336. doi: 10.1093/rheumatology/kex414.
To investigate the prevalence of diabetes in patients with RA and the impact of diabetes on self-reported outcomes and health care.
RA patients between the ages of 18 and 79 years were randomly selected from a nationwide statutory health insurance fund and were surveyed about rheumatological care and disease burden. Comorbid diabetes (E10-14) was analysed regarding age, sex, BMI and socioeconomic status. Disease burden, comorbidity and prescriptions were compared in RA patients with and without diabetes. Predictors of rheumatological care were identified by multivariate regression.
Of the 2535 RA patients, 498 (20%) had diabetes. Diabetes was more frequent in males, in older patients, in patients with a higher BMI and in those with a lower socioeconomic status. All disease outcomes were poorer in RA-diabetes patients and were mainly attributable to a higher BMI. RA-diabetes patients received less DMARDs (40% vs 48%) and had more hospital stays (41% vs 30%) than patients without diabetes (all P < 0.05). Rates of cardiovascular disease (35% vs 15%), depression (39% vs 26%) and renal failure (23% vs 8%) were higher in RA-diabetes patients (all P < 0.0001). They were less frequently treated by rheumatology specialists: 57% vs 67%; odds ratio = 0.64 (95% CI: 0.45, 0.92), after controlling for confounders.
The prevalence of diabetes in patients with RA is high and is associated with known sociodemographic factors. More than 40% of patients with RA and diabetes were not under rheumatological care even though they reported a high disease burden, were frequently hospitalized and often presented with further comorbidities.
调查类风湿关节炎（RA）患者中糖尿病的患病率，以及糖尿病对患者自我报告结局和医疗保健的影响。
从全国法定健康保险基金中随机选择年龄在 18 至 79 岁之间的 RA 患者，并对其进行风湿病护理和疾病负担调查。分析合并糖尿病（E10-14）患者的年龄、性别、体重指数和社会经济地位。比较 RA 患者中合并糖尿病和不合并糖尿病的疾病负担、合并症和处方。采用多元回归分析确定风湿病护理的预测因素。
在 2535 名 RA 患者中，有 498 名（20%）患有糖尿病。糖尿病在男性、年龄较大的患者、BMI 较高的患者和社会经济地位较低的患者中更为常见。所有疾病结局在 RA 合并糖尿病患者中均较差，主要归因于 BMI 较高。RA 合并糖尿病患者接受 DMARDs（40% vs 48%）和住院治疗（41% vs 30%）的比例低于未合并糖尿病的患者（均 P < 0.05）。RA 合并糖尿病患者发生心血管疾病（35% vs 15%）、抑郁（39% vs 26%）和肾衰竭（23% vs 8%）的比例较高（均 P < 0.0001）。尽管这些患者报告疾病负担较高，经常住院且经常出现其他合并症，但他们接受风湿病专家治疗的比例较低：57% vs 67%；比值比=0.64（95%CI：0.45，0.92），在控制混杂因素后。
RA 患者中糖尿病的患病率较高，与已知的社会人口学因素有关。超过 40%的 RA 合并糖尿病患者未接受风湿病护理，尽管他们报告疾病负担较高，经常住院且经常出现其他合并症。
