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Common rheumatoid arthritis treatment shows potential for diabetes prevention
July 11, 2007Far fewer rheumatoid arthritis patients treated with the drug hydroxychloroquine (HCQ) went on to develop diabetes compared to those who never took the drug, according to a 20-plus-year University of Pittsburgh School of Medicine-led study reported today in the Journal of the American Medical Association. In addition, those using HCQ who did develop diabetes were less likely to take medications to manage their disease after diagnosis.
The multi-center observational study of 4,905 adults with rheumatoid arthritis (RA) found that relative risk progressively declined by as much as 77 percent after four years of treatment with HCQ, a common antimalarial medication that also is used for rheumatoid arthritis and other autoimmune disorders.
Additional participating centers in the study are Stanford University, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), one of the National Institutes of Health (NIH) and the University of Cincinnati. Co-investigators at Stanford have directed the project database since its inception with support from the NIH.
"This reduction in risk persisted even after adjusting for other diabetes risk factors among these patients, such as body-mass index, degree of disability and use of corticosteroids," said rheumatologist Mary Chester M. Wasko, M.D., M.Sc., associate professor of medicine, University of Pittsburgh School of Medicine. Because people with RA tend to be less active and take corticosteroids that can cause weight gain, they are often considered to be at higher risk for developing diabetes, a disease in which blood sugar levels become abnormally high because of the body's inability to use or produce the hormone insulin.
"Another interesting finding was that the rheumatoid arthritis patients who developed diabetes were less likely to need blood sugar-lowering medication to manage their disease," said Dr. Wasko, whose clinical research has focused on long-term health improvement in patients with RA. "However, it is most exciting to consider that this drug might be appropriate for people with pre-diabetes as a preventive therapy - much in the same way as a daily baby aspirin is suggested for people at high risk for heart disease."
Nationally, diabetes is the fifth leading cause of death, according to the American Diabetes Association. Many people first become aware of the disease when confronted with one of its life-threatening complications such as heart disease, blindness, high blood pressure, stroke, kidney disease or circulatory problems that can lead to amputation.
Results show that HCQ's association with reduction in diabetes risk is comparable or superior to that of a number of other drugs studied in clinical trials for diabetes prevention and treatment, including rosiglitazone, hormones, metformin, acarbose and ramipril. And recent questions have arisen concerning rosiglitazone, marketed as Avandia, and a reported increased risk of heart attack.
Although HCQ is not without side effects - nausea, headache and dizziness, for example - the drug has a long history of being generally safe and well-tolerated. In addition, Dr. Wasko and her colleagues observed no apparent negative interactions between HCQ and other drugs commonly used by RA patients, such as methotrexate and prednisone. An important limitation of the study, however, is that investigators used self-report information from patients collected in follow-up twice yearly that did not include confirmation by laboratory tests.
Other studies of the blood sugar-lowering effects of HCQ have shown minimal use for the drug as a treatment for people with established diabetes, Dr. Wasko continued, stressing the treatment's real promise may be prevention.
"HCQ already has a role in long-term treatment for RA, potentially moderating lipids and having a weak anti-clotting effect. But, optimistically speaking, endocrinologists can identify people who are at high risk for diabetes, due to obesity, family history, lipid profile or other characteristics. HCQ may also have a role in delaying onset of diabetes," Dr. Wasko said. "More research is needed to verify our findings in people with RA, and also to determine how this medicine works. But my ultimate hope is that this relatively inexpensive, safe drug will be studied as a way to reduce diabetes risk for people who do not have RA."
University of Pittsburgh Schools of the Health Sciences
"This reduction in risk persisted even after adjusting for other diabetes risk factors among these patients, such as body-mass index, degree of disability and use of corticosteroids," said rheumatologist Mary Chester M. Wasko, M.D., M.Sc., associate professor of medicine, University of Pittsburgh School of Medicine. Because people with RA tend to be less active and take corticosteroids that can cause weight gain, they are often considered to be at higher risk for developing diabetes, a disease in which blood sugar levels become abnormally high because of the body's inability to use or produce the hormone insulin.
"Another interesting finding was that the rheumatoid arthritis patients who developed diabetes were less likely to need blood sugar-lowering medication to manage their disease," said Dr. Wasko, whose clinical research has focused on long-term health improvement in patients with RA. "However, it is most exciting to consider that this drug might be appropriate for people with pre-diabetes as a preventive therapy - much in the same way as a daily baby aspirin is suggested for people at high risk for heart disease."
Nationally, diabetes is the fifth leading cause of death, according to the American Diabetes Association. Many people first become aware of the disease when confronted with one of its life-threatening complications such as heart disease, blindness, high blood pressure, stroke, kidney disease or circulatory problems that can lead to amputation.
Results show that HCQ's association with reduction in diabetes risk is comparable or superior to that of a number of other drugs studied in clinical trials for diabetes prevention and treatment, including rosiglitazone, hormones, metformin, acarbose and ramipril. And recent questions have arisen concerning rosiglitazone, marketed as Avandia, and a reported increased risk of heart attack.
Although HCQ is not without side effects - nausea, headache and dizziness, for example - the drug has a long history of being generally safe and well-tolerated. In addition, Dr. Wasko and her colleagues observed no apparent negative interactions between HCQ and other drugs commonly used by RA patients, such as methotrexate and prednisone. An important limitation of the study, however, is that investigators used self-report information from patients collected in follow-up twice yearly that did not include confirmation by laboratory tests.
Other studies of the blood sugar-lowering effects of HCQ have shown minimal use for the drug as a treatment for people with established diabetes, Dr. Wasko continued, stressing the treatment's real promise may be prevention.
"HCQ already has a role in long-term treatment for RA, potentially moderating lipids and having a weak anti-clotting effect. But, optimistically speaking, endocrinologists can identify people who are at high risk for diabetes, due to obesity, family history, lipid profile or other characteristics. HCQ may also have a role in delaying onset of diabetes," Dr. Wasko said. "More research is needed to verify our findings in people with RA, and also to determine how this medicine works. But my ultimate hope is that this relatively inexpensive, safe drug will be studied as a way to reduce diabetes risk for people who do not have RA."
University of Pittsburgh Schools of the Health Sciences
Diabetes Prevention Current Events and Diabetes Prevention News RSSA decade later, lifestyle changes or metformin still lower type 2 diabetes risk
Intensive lifestyle changes aimed at modest weight loss reduced the rate of developing type 2 diabetes by 34 percent compared with placebo in people at high risk for the disease, researchers conclude based on 10 years of data.
Pregnant women with mildly abnormal blood sugar levels at higher risk of developing type 2 diabetes
Gestational diabetes happens in more than three per cent of pregnancies in Ontario. Usually the condition resolves itself after delivery, but many studies have shown that these women are at a very high risk for developing "regular" type 2 diabetes later in life.
Overweight siblings of children with type 2 diabetes likely to have abnormal blood sugar levels
Overweight siblings of children with type 2 diabetes are four times more likely to have abnormal glucose levels compared to other overweight children. Because abnormal glucose levels may indicate risk for diabetes or diabetes itself, these children could benefit from screening tests and diabetes prevention education.
Dance to the music: Learning and exercising at YMCA can prevent diabetes
Community-based exercise organizations, such as the YMCA, are an effective tool in the fight against diabetes, according to a study by Indiana University School of Medicine researchers in the October 2008 issue of the American Journal of Preventive Medicine.
Community-based diabetes prevention program shows promise
With over 60 million Americans diagnosed with prediabetes, putting them at increased risk for diabetes, cardiovascular events and other obesity-related ailments, finding ways to help large populations avoid these complications is an important initiative.
Children's Hospital studying drug with the potential to prevent/delay onset of type 1 diabetes
Researchers at Children's Hospital of Pittsburgh of UPMC are participating in an international clinical trial currently underway to study the effectiveness of oral insulin in preventing or delaying the onset of type 1 diabetes in people at risk for the disease.
New diabetes report documents devastating effects in New York City
The diabetes epidemic is taking a large and growing toll on New York City, a new Health Department report shows, as death rates, debilitating complications, and hospitalization costs soar.
Selenium Supplements May Increase the Risk of Type 2 Diabetes
Selenium, an antioxidant included in multivitamin tablets thought to have a possible protective effect against the development of type 2 diabetes, may actually increase the risk of developing the disease.
Women with diabetes left behind in drop in death rates
A new analysis of data from three large national databases finds that in the 29 years between 1971 and 2000, the death rate of men with diabetes has dropped significantly, in line with the overall decline of the death rate for all Americans. But the death rate for women with diabetes did not decline at all.
Can we prevent type 1 diabetes by modifying infant nutrition?
Within the next 10 years the EU-funded Diabetes Prevention study, part of an international study called TRIGR (Trial to Reduce IDDM in the Genetically at Risk), coordinated at the University of Helsinki, Finland, will generate a definite answer to the question whether early nutritional modification may prevent type 1 diabetes later in childhood.
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