title: Diabetes is an independent predictor for severe osteoarthritis: results from a longitudinal cohort study.
abstract: OBJECTIVE
  To evaluate if type 2 diabetes is an independent risk predictor for severe osteoarthritis (OA).
  
  
  METHODS
  Population-based cohort study with an age- and sex-stratified random sample of 927 men and women aged 40-80 years and followed over 20 years (1990-2010).
  
  
  RESULTS
  Rates of arthroplasty (95% CI) were 17.7 (9.4-30.2) per 1,000 person-years in patients with type 2 diabetes and 5.3 (4.1-6.6) per 1,000 person-years in those without (P < 0.001). Type 2 diabetes emerged as an independent risk predictor for arthroplasty: hazard ratios (95% CI), 3.8 (2.1-6.8) (P < 0.001) in an unadjusted analysis and 2.1 (1.1-3.8) (P = 0.023) after adjustment for age, BMI, and other risk factors for OA. The probability of arthroplasty increased with disease duration of type 2 diabetes and applied to men and women, as well as subgroups according to age and BMI. Our findings were corroborated in cross-sectional evaluation by more severe clinical symptoms of OA and structural joint changes in subjects with type 2 diabetes compared with those without type 2 diabetes.
  
  
  CONCLUSIONS
  Type 2 diabetes predicts the development of severe OA independent of age and BMI. Our findings strengthen the concept of a strong metabolic component in the pathogenesis of OA.
authors.affiliation: Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany. georg.schett@uk-erlangen.de
authors.forename: Georg
authors.initials: G
authors.lastname: Schett
authors.forename: Arndt
authors.initials: A
authors.lastname: Kleyer
authors.forename: Carlo
authors.initials: C
authors.lastname: Perricone
authors.forename: Enijad
authors.initials: E
authors.lastname: Sahinbegovic
authors.forename: Annamaria
authors.initials: A
authors.lastname: Iagnocco
authors.forename: Jochen
authors.initials: J
authors.lastname: Zwerina
authors.forename: Rolando
authors.initials: R
authors.lastname: Lorenzini
authors.forename: Franz
authors.initials: F
authors.lastname: Aschenbrenner
authors.forename: Francis
authors.initials: F
authors.lastname: Berenbaum
authors.forename: Maria-Antonietta
authors.initials: MA
authors.lastname: D'Agostino
authors.forename: Johann
authors.initials: J
authors.lastname: Willeit
authors.forename: Stefan
authors.initials: S
authors.lastname: Kiechl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000453:epidemiology*; D012307:Risk Factors