Background/Purpose: The impact of concomitant comorbidities on RA outcomes is of high interest, and some evidence suggests that patients (pts) with RA and diabetes may have worse clinical outcomes and adverse events compared with pts with RA without diabetes. Therefore, we evaluated the effects of diabetes on change in HAQ score and infection in pts with RA, comparing those with diabetes to those without diabetes.

Methods: Using the ACR’s Rheumatology Informatics System for Effectiveness (RISE) electronic health record-based registry, we identified pts with RA who had ≥1 rheumatologist visit with a valid HAQ measurement (index visit) in 2016. Eligible pts had ≥1 previous visit and a subsequent outcome visit with any HAQ measured at 12 months (±3 months) after the index visit. Prior to the index visit, diabetes was identified based on ≥1 ICD-9 or ICD-10 diagnosis code, any medication for diabetes or elevated diabetes biomarkers (hemoglobin A_1c, random glucose). Mean HAQ change between the index and outcome visit was calculated based on HAQ categories at the index visit (0–0.5, 0.5–1 and 1–3). Generalized linear models were used to calculate the adjusted mean HAQ change controlling for potential confounders (e.g., demographics, conventional DMARDs, biologic DMARDs). First infection during follow-up was defined by ICD-9 or ICD-10 diagnosis codes or anti-infective medications. We calculated the incidence rate (IR) of infections among pts with and without diabetes and compared hazard ratios (HR) using Cox regression adjusting for potential confounders.

Results: Among 457,950 pts in the 2016 RISE registry, there were 3897 pts with RA with diabetes and 18,689 without diabetes in the final cohort. Overall, the mean HAQ change between index and outcome visit was 0.03 in pts with diabetes and 0.002 in pts without diabetes (p<0.01). After stratifying on baseline HAQ and comparing with pts without diabetes, pts with diabetes and RA worsened more and improved less, depending on their baseline HAQ (Table 1). Among those with diabetes, we identified 935 infections, yielding an IR of 27.9 (95% CI: 26.2, 29.8) per 100 person years. For pts without diabetes, we identified 3989 infections with an IR of 24.4 (95% CI: 23.7, 25.2). After adjusting for potential confounders, the HR of infection among diabetes pts (HR: 1.09; 95% CI: 0.94, 1.26) was not significantly different to pts without diabetes.

Conclusion: Among pts with RA, those with diabetes had greater worsening, or less improvement, in their functional status. These results suggest additional interventions may be needed for pts with RA and diabetes to optimize this and other comorbidities.

Disclaimer: This data was supported by the ACR’s RISE Registry. However, the views expressed represent those of the authors, not necessarily those of the ACR.

Medical writing assistance provided by Carol Keys, PhD (Caudex), funded by Bristol-Myers Squibb.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effect-of-concomitant-diabetes-on-ra-related-outcomes-results-from-the-acrs-rise-registry/