Background/Purpose: Evidence suggest that autoimmune diseases tend to coexist at a higher rate than expected, reflecting a common pathogenetic pathway. However, data sets have shown an inverse association between certain autoimmune diseases, such as in Rheumatoid Arthritis and Multiple Sclerosis. In this study we investigate the co-occurrence of systemic sclerosis (SSc), Systemic lupus Erythematosus(SLE) and Sjogren Syndrome (SS) In patient with type 1 and type 2 diabetes mellitus (DM).

Methods: Health Care and Utilization Project (HCUP) data for the year 2019 was searched using ICD10 codes. We identified 80245 patients with Type 1 DM, 1593743 patients with Type 2 DM, 6412 with SSc, and 521 SSc patients with lung involvement, 11458 patients with SS, 25407 patients with SLE, and 4887 patients with lupus nephritis (LN). We used weighted logistic regression to examine the association between each of these diseases and diabetes.

Results: The prevalence of SSc among patients with Type 1 DM was significantly lower than that for the non-DM control group (0.0006 vs. 0.0009, p-value= 0.0064). Similarly, a lower prevalence was noted among patients with Type 2 DM (0.0007 vs 0.001, P-value < 0.0001 ).

The prevalence of SSc with lung involvement among patients with Type 1 DM was lower than that in the control. However, the difference was not statistically significant (p = 0.1049). While the prevalence of SSc with lung involvement, among patients with Type 2 DM was significantly lower than the control group (0.0005 vs. 0.0008, P-value < 0.0001).

The prevalence of SLE among patients with type 1 diabetes was lower than the non-diabetes control group (0.0041 vs. 0.0046, P-value = 0.0566). Interestingly the prevalence of LN was lower among patients with type 1 diabetes (0.0005% vs 0.0008, P-value = 0.0008).

The Prevalence of SLE in type 2 diabetes was lower compared to non-DM control group, however this was not statistically significant (P-value = 0.0651). There was significant decrease in prevalence of LN with type 2 DM (0.0004 vs 0.0009, P-value < 0.001)

Similarly, there was significant decrease of prevalence of SS in patients with type 1 diabetes (0.0011 vs. 0.0017, P-value < 0.0001). Prevalence of SS was significantly lower in patient with type 2 DM (0.0015 vs 0.0018, P-value < 0.001).

Conclusion: The collected data demonstrates an inverse relation between some autoimmune connective tissue disease such as SSc, lupus, and SS in patients with DM. This suggests that these diseases and DM may have different immune pathogenesis. There was also significantly lower incidence of organ complications such as lupus nephritis and SSc lung disease among patients with diabetes suggesting that diabetes and treatment of diabetes may alter the clinical course of these disorders.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/decreased-prevalence-of-autoimmune-connective-tissue-diseases-in-type-1-and-type-2-diabetes/