Risk of Diabetes Mellitus in Patients with Systemic Lupus Erythematosus Can be Reduced with the Use of Hydroxychloroquine

A recent study conducted by a team of researchers from Taiwan found that patients with Systemic lupus erythematosus (SLE) who are treated with a specific dose of an antimalarial drug UCQ) are less prone to develop diabetes mellitus. However, those SLE patients that are threated with high-dose glucocorticoids are at higher risk of diabetes. Still, according the findings, this risk can be decreased if glucocorticoids are given in combination with HCQ. The study entitled “Hydroxychloroquine reduces risk of incident diabetes mellitus in lupus patients in a dose-dependent manner: a population-based cohort study”, was recently published in journal Rheumatology.

Systemic lupus erythematosus (SLE) is associated with early atherosclerosis and cardiovascular diseases. Moreover, chronic inflammation contributes to insulin resistance, which commonly precedes the development of diabetes mellitus, with evidence showing that patients with SLE are at a higher risk of this condition. Common therapeutics for SLE include high-dose glucocorticoids that may worsen glucose homoeostasis, thus complicating diabetes. However, Hydroxychloroquine  (HCQ) can reduce diabetes risk in Rheumatoid Arthritis. In this regard, Der-Yuan Chen from the Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine in Taiwan and colleagues tested the association of HCQ use and diabetes mellitus risk in SLE patients.

The team of researchers conducted a population-based study with 8,628 SLE patients. Data was retrieved from the Taiwan National Health Insurance Research Database from 2001 to 10. To determine the incidence of diabetes, the researchers used a new diagnostic code.

Results revealed 221 cases of diabetes mellitus patients among the total SLE population. From the total SLE patients 6,795 had been prescribed HCQ and 1,833 had never taken HCQ. Longitudinal analyses were conducted within a median follow-up period of 5.6 years.

Then the researchers compared the incidence of diabetes mellitus between those SLE patients that had taken HCQ vs. those who never took the drug, and found less risk of diabetes in those taking HCQ (dose >129g). Furthermore, results revealed that those that were taking daily glucocorticoid (≥10 mg) were at higher risk developing diabetes mellitus. However, this risk was reduced when patients were given a combination of HCG (≥129 g) and glucocorticoid (≥10 mg).

Findings from this study strongly indicate that HCQ use is associated with reduced incident diabetes mellitus risk in a dose-dependent manner among patients with SLE, with the team of researchers concluding that glucocorticoid-induced diabetes mellitus can be ameliorated by concomitant use of HCQ at a cumulative dose ≥129 g.