Glucose tolerance, insulin sensitivity and β-cell function in patients with rheumatoid arthritis treated with or without low-to-medium dose glucocorticoids
Glucose tolerance, insulin sensitivity and β-cell function in patients with rheumatoid arthritis treated with or without low-to-medium dose glucocorticoids
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DOI：
10.1136/ard.2011.151464
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发表时间：
2011-11-01
影响因子：
27.4
通讯作者：
Bijlsma, J. W. J.
中科院分区：
文献类型：
--
作者：
Hoes, J. N.;van der Goes, M. C.;Bijlsma, J. W. J.
目的比较类风湿关节炎(RA)患者糖耐量、胰岛素敏感性和胰岛β细胞功能参数。方法对58例长期使用糖皮质激素(GC)和82例未应用糖皮质激素(GC)的类风湿关节炎(RA)患者和50例年龄相当的正常糖耐量的对照组进行75g口服葡萄糖耐量试验。结果糖耐量、胰岛素敏感性和胰岛β细胞功能在两组RA患者中无明显差异，11%的RA患者存在初发T2 DM，35%的RA患者存在糖代谢异常。在RA患者中，累积GC剂量与T2 DM相关，这似乎主要是由累积GC剂量对胰岛素抵抗的影响驱动的；然而，当校正当前疾病活动时，这种相关性降低。多因素回归分析显示RA的存在与胰岛素敏感性呈负相关。结论类风湿关节炎患者与健康对照组相比，代谢参数相近，胰岛素敏感性和胰岛β细胞功能降低。尽管累积GC剂量显示对糖耐量状态和胰岛素敏感性有负面影响，但适应症混淆仍然是这项横断面分析中的主要挑战。
Objectives To compare glucose tolerance and parameters of insulin sensitivity and beta-cell function between chronic glucocorticoid (GC)-using and GC-naive patients with rheumatoid arthritis (RA).Methods Frequently sampled 75 g oral glucose tolerance tests were performed in 58 chronic GC-using and 82 GC-naive patients with RA with established disease, with no known type 2 diabetes mellitus (T2DM), and 50 control subjects of comparable age with normal glucose tolerance. The associations between cumulative GC dose and disease characteristics and glucose tolerance state, insulin sensitivity and beta-cell function were tested using multivariate linear and logistic regression models, correcting for patient characteristics.Results Glucose tolerance state, insulin sensitivity and beta-cell function did not differ between the two RA populations; de novo T2DM was detected in 11% and impaired glucose metabolism in 35% of patients with RA. In patients with RA, cumulative GC dose was associated with T2DM, which seemed mostly driven by the effects of cumulative GC dose on insulin resistance; however, the association decreased when corrected for current disease activity. Patients with RA had decreased insulin sensitivity and impaired beta-cell function compared with controls, and multivariate regression analyses showed a negative association between the presence of RA and insulin sensitivity.Conclusions GC-using and GC-naive patients with RA had comparable metabolic parameters, and had decreased insulin sensitivity and beta-cell function as compared with healthy controls. Although cumulative GC dose was shown to have a negative impact on glucose tolerance state and insulin sensitivity, confounding by indication remains the main challenge in this cross-sectional analysis.