Abstract
Association between diabetes mellitus (diabetes) and risk of knee osteoarthritis (KOA) is confounded by high body mass index (BMI), a strong risk factor for both conditions. We evaluated the association between diabetes and incidence of total knee replacement (TKR) due to severe KOA in the Singapore Chinese Health Study, a prospective cohort of 63,257 Chinese men and women, aged 45–74 years at recruitment in 1993–1998, and re-interviewed in 1999–2004. Height, weight, lifestyle factors and history of diabetes were obtained through in-person interviews at recruitment and re-interview. Incident cases of TKR were identified via record linkage with nationwide hospital discharge database. Subjects with/without prevalent diabetes had comparable BMI (24.0 kg/m2 versus 23.0 kg/m2). After an average of 14-years, 1,973 subjects had TKR attributable to KOA. Compared to subjects without diabetes, hazard ratio (HR) of TKR for subjects with diabetes was 0.63 [95% confidence interval (CI), 0.52–0.75] after controlling for BMI and other risk factors. An inverse association was also observed between incident diabetes at re-interview and subsequent risk of TKR (HR = 0.74; 95% CI = 0.58–0.94). The inverse diabetes-TKR risk association was similar by gender and across three categories of BMI. Our study does not support diabetes as a risk factor of KOA.
Highlights
Recent data from epidemiologic studies suggest that diabetes mellitus and/or hyperglycaemia may be risk factors for severe KOA8
When we confined our analysis to subjects without prevalent diabetes at recruitment, the inverse association between incident diabetes reported at follow-up and total knee replacement (TKR) remain unchanged after adjusting for body mass index (BMI) and all other established and potential risk factors associated with severe knee osteoarthritis (KOA) (Table 3), and the risk estimates were again similar between men and women (p for interaction = 0.68)
In this study, using subjects from the Singapore Chinese Health Study cohort, which is a relatively lean population with comparable BMI between subjects with or without diabetes, we found a statistically significant inverse association between diabetes and risk of TKR after controlling for BMI and other potential confounding factors
Summary
Ying-Ying Leung[1,2], John Carson Allen[1], Li-Wei Ang[3], Jian-Min Yuan4,5 & Woon-Puay Koh[1,6]. We evaluated the association between diabetes and incidence of total knee replacement (TKR) due to severe KOA in the Singapore Chinese Health Study, a prospective cohort of 63,257 Chinese men and women, aged 45–74 years at recruitment in 1993–1998, and re-interviewed in 1999–2004. Epidemiological studies in populations with low BMI are needed to minimize the confounding effect of obesity on the diabetes-KOA risk association. We used data from the Singapore Chinese Health Study (SCHS), a prospective cohort of middle-aged or older Chinese men and women with an average baseline BMI of kg/m2 compared to kg/m2 for subjects with diabetes, to assess the effect of diabetes on risk of TKR due to KOA independent of obesity. We excluded 4,022 subjects with prevalent diabetes at recruitment and further 330 cases with TKR between
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