Abstract
Systemic lupus erythematosus (SLE) patients are associated with insulin resistance and are at higher risk to develop diabetes mellitus (DM). SLE and DM could lead to renal failure respectively. However, it is unknown whether DM increases the risk of end-stage renal disease (ESRD) in SLE patients. This study aimed to evaluate potential synergistic effect of DM on SLE patients for development of ESRD. We conducted this study by using National Health Insurance Research Database of Taiwan. We recruited SLE patients with newly-diagnosed DM as the study cohort. A comparison cohort at a 1:1 ratio of SLE patients without DM matched by age, sex, age at the diagnosis of SLE, duration between diagnosis of SLE and DM, and various comorbidities through propensity score matching were recruited. After 5.01 ± 3.13 years follow-up, the incidence of ESRD was significantly higher in the DM group than in the non-DM group (Incidence rate ratio: 2.71; 95% CI: 1.70–4.32). After control of confounding factors, DM was not an independent risk factor of ESRD. After starting dialysis, DM patients had a similar mortality rate to those without DM. In summary, SLE patients superimposed with subsequent DM are associated with potentially higher risk to develop ESRD.
Highlights
Systemic lupus erythematosus (SLE) is associated with an increased risk of development of diabetes mellitus (DM)
The cumulative incidence of end-stage renal disease (ESRD) was significantly higher in DM group than non-DM group [9.80 vs. 3.62 per 1000 person-years, p < 0.0001; incidence rate ratio (IRR): 2.71, 95% confidence interval (CI): 1.70–4.32)] (Table 2)
The main finding of this study was that SLE patients superimposed with DM had a higher cumulative incidence of ESRD than those without DM after long-term follow-up
Summary
SLE is associated with an increased risk of development of diabetes mellitus (DM). A cohort study in Toronto documented that women with SLE had a significantly higher prevalence of diabetes mellitus than the age-matched healthy controls (5% versus 1%)[7]. DM and SLE lead to renal failure in different pathways and are two independent risk factors for ESRD. It is unclear whether DM has an additive effect on SLE patients in the progression to ESRD. The difference of the long-term survival between patients with SLE alone and SLE concomitant with DM after development of ESRD is still unknown. We hypothesized that patients with both SLE and DM were at higher risk for developing ESRD and had worse long-term survival
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