Table 1 — Effects of Immune-Modulating Agents on Type 2 Diabetic Patients1

Medication


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Use

Evidence

Colchicine

Gout prophylaxis and treatment

• Placebo-controlled crossover study (12 patients): significantly lower glucose level measured by oral glucose tolerance test in patients taking colchicine

• Large retrospective cohort study: colchicine did not cause a significantly lower diabetes incidence

Dapsone

Off-label for complications of lupus and vasculitides

• Can falsely lower HbA1c measurements

• Diabetic patients should be monitored with fructosamine or glycated albumin after initiation of medication

• Screen for type 2 diabetes using fasting serum glucose (two occasions) or a 2 hour oral glucose tolerance test

Glucocorticoids

Widely used for their anti-inflammatory and immunosuppressive properties

• Produces hyperglycemia

• Can cause new-onet diabetes in non-diabetic patients

Hydroxychloroquine

RA, systemic lupus erythematosus, and off-label for a variety of other conditions

• Case reports: caused hypoglycemia in non-diabetic patients

• Demonstrated antihyperglycemic effects in patients with type 2 diabetes in various studies

o RCT: reduction of HbA1c by 1.02% (95% CI 1.24%, 1.81%) when added to sulfonylurea therapy (duration: 18 months)

o Significantly reduced HbA1c compared to placebo when added to insulin therapy (duration: 6 months)

o Non-inferiority trial: similar antihyperglycemic efficacy compared to pioglitazone

o Small retrospective cohort study: greater reduction in HbA1c from baseline to lowest value within 12 months of therapy compared to methotrexate

• Four large cohort studies: prevented incident diabetes in adults with rheumatologic disease (most likely type 2 diabetic patients based on participant age)

Methotrexate

RA, JIA, and off-label for a variety of other conditions

• Very little evidence regarding effect on diabetes; evidence found suggests there are no significant effects

Sulfasalazine

Mild-moderate RA and JIA, and off-label for a variety of other conditions

• Can falsely lower HbA1c measurements

• Diabetic patients should be monitored with fructosamine or glycated albumin after initiation of medication

• Screen for type 2 diabetes using fasting serum glucose (two occasions) or a 2 hour oral glucose treatment test

TNF Inhibitors

RA, psoriatic arthritis, ankylosing spondylitis, JIA, and off-label for a variety of other conditions

• Evidence suggests improvement in glycemic control

o Retrospective study with 8 patients treated with etanercept or infliximab: lower fasting glucose after treatment with TNF inhibitors compared to other treatment

o Case reports of patients treated with etanercept and adalimumab: improved glycemic control and/or hypoglycemic episodes

o Case report of 1 patient treated with infliximab: able to discontinue insulin therapy during infliximab treatment; required insulin therapy once infliximab was discontinued

• Large retrospective cohort study: decrease in the risk of incident diabetes in rheumatologic patients (most likely type 2 diabetes patients based on participant age)

Anakinra (IL-1 Inhibitor)

RA

• Antihyperglycemic effects in type 2 diabetic patients

o RCT of overweight adults with type 2 diabetes: 0.46% reduction in HbA1c in patients taking anakinra versus placebo after 13 weeks (95% CI 0.01%, 0.90%)

o Case series (2 patients): improved glycemic control when taking anakinra

Abbreviations: IL – interleukin; JIA – juvenile idiopathic arthritis; RA – rheumatoid arthritis; RCT – randomized controlled trial; TNF – tumor necrosis factor