title: Diabetes mellitus and the risk of total knee replacement among Chinese in Singapore, the Singapore Chinese Health Study.
abstract: Association between diabetes mellitus (diabetes) and risk of knee osteoarthritis (KOA) is confounded by high body mass index (BMI), a strong risk factor for both conditions. We evaluated the association between diabetes and incidence of total knee replacement (TKR) due to severe KOA in the Singapore Chinese Health Study, a prospective cohort of 63,257 Chinese men and women, aged 45-74 years at recruitment in 1993-1998, and re-interviewed in 1999-2004. Height, weight, lifestyle factors and history of diabetes were obtained through in-person interviews at recruitment and re-interview. Incident cases of TKR were identified via record linkage with nationwide hospital discharge database. Subjects with/without prevalent diabetes had comparable BMI (24.0 kg/m2versus 23.0 kg/m2). After an average of 14-years, 1,973 subjects had TKR attributable to KOA. Compared to subjects without diabetes, hazard ratio (HR) of TKR for subjects with diabetes was 0.63 [95% confidence interval (CI), 0.52-0.75] after controlling for BMI and other risk factors. An inverse association was also observed between incident diabetes at re-interview and subsequent risk of TKR (HR = 0.74; 95% CI = 0.58-0.94). The inverse diabetes-TKR risk association was similar by gender and across three categories of BMI. Our study does not support diabetes as a risk factor of KOA.
authors.affiliation: Duke-NUS Medical School, Singapore.|Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.
authors.forename: Ying-Ying
authors.initials: YY
authors.lastname: Leung
authors.affiliation: Duke-NUS Medical School, Singapore.
authors.forename: John Carson
authors.initials: JC
authors.lastname: Allen
authors.affiliation: Epidemiology &Disease Control Division, Ministry of Health, Singapore.
authors.forename: Li-Wei
authors.initials: LW
authors.lastname: Ang
authors.affiliation: Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, USA.|Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Yuan
authors.affiliation: Duke-NUS Medical School, Singapore.|Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Woon-Puay
authors.initials: WP
authors.lastname: Koh
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D015992:Body Mass Index; D048909:Diabetes Complications / Q000453:epidemiology* / Q000601:surgery; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D016016:Proportional Hazards Models; D011446:Prospective Studies; D062486:Public Health Surveillance; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology / Q000208:ethnology