Type 2 diabetes risk in sarcoidosis patients untreated and treated with corticosteroids
- Joshua P. Entrop1,
- Susanna Kullberg2,3,
- Johan Grunewald2,3,
- Anders Eklund2,3,
- Kerstin Brismar4 and
- Elizabeth V. Arkema1
- 1Karolinska Institutet, Department of Medicine Solna, Clinical Epidemiology Division, Stockholm, Sweden
- 2Karolinska Institutet, Department of Medicine Solna, Division of Respiratory Medicine, Stockholm, Sweden
- 3Karolinska University Hospital, Department of Respiratory Medicine, Theme Inflammation and Infection, Stockholm, Sweden
- 4Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm, Sweden
- Joshua P. Entrop, Karolinska Institutet, K2 Medicin, Solna, K2 Klinisk epidemiologi, 171 77 Stockholm, Sweden. E-mail: joshua.entrop{at}ki.se
Abstract
Background The rate of type 2 diabetes mellitus (T2D) is increased in sarcoidosis patients but it is unknown if corticosteroid treatment plays a role. We investigated whether the T2D risk is higher in untreated and corticosteroid-treated sarcoidosis patients compared to the general population.
Methods In this cohort study individuals with ≥2 ICD codes for sarcoidosis were identified from the Swedish National Patient Register (NPR; n=5754). Corticosteroid dispensations ±3 months from first sarcoidosis diagnosis were identified from the Prescribed Drug Register (PDR). General population comparators without sarcoidosis were matched to cases 10:1 on age, sex and region of residence (n=61 297). Incident T2D was identified using ICD codes (NPR) and antidiabetic drug dispensations (PDR). Follow-up was from second sarcoidosis diagnosis/matching date until T2D, emigration, death or study end (Dec 2013). Cox regression models adjusted for age, sex, education, country of birth, healthcare regions and family history of diabetes estimated hazard ratios (HR 95%CI). We used flexible parametric models to examine the T2D risk over time.
Results 40% of sarcoidosis patients were corticosteroid-treated at diagnosis. The T2D rate was 7.7/1000 person-years in untreated sarcoidosis, 12.7 in corticosteroid-treated sarcoidosis and 5.5 in comparators. The HR for T2D was 1.4 (95%CI 1.2–1.8) associated with untreated sarcoidosis and 2.3 (95%CI 2.0–3.0) associated with corticosteroid-treated sarcoidosis. The T2D risk was highest for corticosteroid-treated sarcoidosis in the first 2 years after diagnosis.
Conclusion Sarcoidosis is associated with an increased risk of T2D especially in older, male, corticosteroid-treated patients at diagnosis. Screening for T2D for these patients is advisable.
Footnotes
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Conflict of interest: Dr. Entrop has nothing to disclose.
Conflict of interest: Dr. Kullberg has nothing to disclose.
Conflict of interest: Dr. Grunewald has nothing to disclose.
Conflict of interest: Dr. Eklund has nothing to disclose.
Conflict of interest: Dr. Brismar has nothing to disclose.
Conflict of interest: Dr. Arkema has nothing to disclose.
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- Received January 13, 2021.
- Accepted March 7, 2021.
- Copyright ©The authors 2021
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