Another study found that addition of hydroxychloroquine to insulin therapy significantly reduced a patient’s HbA1c value versus placebo after 6 months. A small retrospective cohort study also discussed in this review found that, compared to methotrexate, hydroxychloroquine had a greater HbA1c reduction from baseline to the lowest value obtained within 12 months of therapy. Hydroxychloroquine also demonstrated its glycemic effect in a non-inferiority trial, which found it to have comparable antihyperglycemic efficacy to pioglitazone.  

Pilla et al also discussed several important factors that should be considered for patients with rheumatologic disease.1 First, immune-modulating agents that possess antihyperglycemic properties should be utilized in rheumatologic patients with type 2 diabetes or type 2 diabetes risk factors. As seen by the results of various studies discussed in this review, hydroxychloroquine is the preferred agent in patients with difficult to control hyperglycemia who require immune-modulating therapy. In addition, based on the evidence of several cohort studies, hydroxychloroquine or a TNF inhibitor may be considered in patients at risk of developing type 2 diabetes.

Another important aspect in the management of a patient with a rheumatologic condition is the appropriate monitoring of that patient after initiation of an immune-modulating agent. Although the glycemic effect of immune modulators is not always immediate, it is important for a patient to be informed of the risk of hypoglycemia as well as the symptoms that may occur prior to the initiation of therapy. The authors also stated that collaboration with the patient, as well as their full care team, is crucial for successful disease management.


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Immune modulators are effective medications used in the treatment of several rheumatologic conditions. Many of these agents also produce endocrine effects in patients, which are important for providers to know about and thoroughly understand. Although several studies have been completed, additional analyses regarding the effects of these medications on diabetes and cardiovascular outcomes are needed in the future.

References 

1. Pilla SJ, Quan AQ, Germain-Lee EL, Hellmann DB, Mathioudakis NN. Immune-Modulating Therapy for Rheumatologic Disease: Implications for Patients with Diabetes. Current Diabetes Report. 2016 Oct;16(10):91. DOI: 10.1007/s11892-016-0792-9.