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Immune-Modulating Therapy for Rheumatologic Disease: Implications for Patients with Diabetes
Scott J Pilla1, Amy Q Quan2, Emily L Germain-Lee3,4
1General Internal Medicine, Johns Hopkins University, 2024 E. Monument St, Room 2-604A, Baltimore, MD, 21205, USA.
Current Diabetes Reports
|August 16, 2016
Summary
Immune modulators for rheumatologic diseases impact diabetes management, affecting blood sugar and requiring careful provider coordination. Awareness of these endocrine effects is crucial for patient safety and effective treatment.
Area of Science:
- Endocrinology
- Rheumatology
- Immunology
Background:
- Rheumatologic diseases and diabetes frequently coexist, sharing significant cardiovascular risks.
- Immune modulators, used for rheumatologic conditions, can influence endocrine function, particularly in diabetic patients.
Purpose of the Study:
- To review the diverse endocrine effects of immune modulators in patients with and without diabetes.
- To highlight the implications for diabetes management and the need for coordinated care.
Main Methods:
- Literature review of clinical trials and observational studies on immune modulators in rheumatologic diseases.
- Analysis of endocrine effects, including glycemic control and pancreatic function, in diabetic and non-diabetic populations.
Main Results:
- Early immune modulator use in type 1 diabetes may improve pancreatic function; efficacy in adults with longstanding disease is unclear.
- Hydroxychloroquine shows antihyperglycemic effects in type 2 diabetes, potentially aiding glycemic control.
- Hydroxychloroquine and TNF inhibitors may reduce diabetes incidence in non-diabetic individuals.
- Dapsone and sulfasalazine can interfere with HbA1c measurements due to altered erythrocyte survival.
Conclusions:
- Immune modulators have varied endocrine effects, necessitating individualized medication selection and careful monitoring in diabetic patients.
- Coordinated care between rheumatologists and endocrinologists is essential to prevent adverse events like hypoglycemia.
- Further research is required to understand the long-term outcomes of immune modulators in patients with diabetes.
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