title: Immune-Modulating Therapy for Rheumatologic Disease: Implications for Patients with Diabetes.
abstract: Immune modulators used to treat rheumatologic disease have diverse endocrine effects in patients with diabetes. Providers should be aware of these effects given that diabetes and rheumatologic disease overlap in prevalence and cardiovascular morbidity. In patients with type 1 diabetes, clinical trials have demonstrated that immune modulators used early in the disease can improve pancreatic function, though their efficacy in adults with longstanding autoimmune diabetes is unknown. In patients with type 2 diabetes, hydroxychloroquine is an effective antihyperglycemic and may be preferred for rheumatologic use in patients with difficult glycemic control. In patients without diabetes, hydroxychloroquine and tumor necrosis factor (TNF) inhibitors have been found to decrease diabetes incidence in observational studies. Additionally, dapsone and sulfasalazine alter erythrocyte survival resulting in inaccurate HbA1c values. These multifaceted effects of immune modulators create a need for coordinated care between providers treating patients with diabetes to individualize medication selection and prevent hypoglycemic events. More research is needed to determine the long-term outcomes of immune modulators in patients with diabetes.
authors.affiliation: General Internal Medicine, Johns Hopkins University, 2024 E. Monument St, Room 2-604A, Baltimore, MD, 21205, USA.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Pilla
authors.affiliation: Johns Hopkins School of Medicine, 2202 E Fairmount Ave, Baltimore, MD, 21231, USA.
authors.forename: Amy Q
authors.initials: AQ
authors.lastname: Quan
authors.affiliation: Department of Pediatrics, Division of Pediatric Endocrinology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.|Kennedy Krieger Institute, Broadway, Room 583, Baltimore, MD, 801 N, USA.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Germain-Lee
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine and Johns Hopkins, Bayview, Johns Hopkins Bayview Medical Center, Mason F. Lord Building, Center Tower, Room 322, 5200 Eastern Avenue, Baltimore, MD, 21224, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Hellmann
authors.affiliation: Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, 1830 E. Monument Street, Suite 333, Baltimore, MD, 21287, USA. nmathio1@jhmi.edu.
authors.forename: Nestoras N
authors.initials: NN
authors.lastname: Mathioudakis
mesh_terms: D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D012216:Rheumatic Diseases / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D007004:Hypoglycemic Agents; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha
keywords: Antirheumatic agents; Diabetes mellitus; Hypoglycemia; Immunomodulation; Immunosuppressive agents; Rheumatic diseases