Use of glitazones and the risk of elective HIP or knee replacement: A population based case-control study

Background: Osteoarthritis (OA) is the most common musculoskeletal condition in the elderly population. However, to date, no disease modifying drug exists for this disease. In vivo studies have shown that glitazones may be used as anti-arthritic drugs. (Kobayashi, 2005; Boileau, 2007). Objectives: To determine the risk of total joint replacement (TJR) with the use of glitazones. Methods: A population based case-control study was performed using the Clinical Practice Research Datalink (CPRD). Cases (n=94,609) were defined as patients >18 years of age who had undergone TJR surgery between 2000 and 2012. Controls were matched by age, gender and general practice. Conditional logistic regression was used to estimate the risk of total knee (TKR) and total hip replacement (THR) associated with use of glitazones. We additionally evaluated risk of TJR in current glitazone users compared to DM patients using other antidiabetic drugs (ADs). In order to determine a dose effect relationship, we also stratified glitazone users by total number of prescriptions prior to surgery. Results: There is no difference in risk of TKR (OR=1.11 (95% CI=0.95-1.29)) or THR (OR=0.87 (95% CI=0.74-1.02)) between glitazone users and patients not using glitazones. Furthermore, there is no difference in risk of TKR (OR=1.03 (95% CI=0.88-1.22)) and THR (OR=0.90 (95% CI=0.75-1.08)) when glitazones users are compared to other AD users. Finally, we did not find a dose response effect with increasing number of prescriptions. Conclusions: This study did not find any evidence for an anti-arthritic effect of glitazones

Use of parenteral glucocorticoids and the risk of new onset type 2 diabetes mellitus : A case-control study

Background: Use of oral glucocorticoids (GCs) has been associated with hyperglycaemia and type 2 diabetes mellitus (T2DM). However, unlike oral GCs, there is minimal or no data on the effect of parenteral GC use on T2DM. Objective: To assess the association between use of parenteral GCs and the risk of receiving a first prescription of a non-insulin antidiabetic drug (NIAD) as a proxy for new onset of T2DM. Methods: A population based case-control study was performed using the Clinical Practice Research Datalink (CPRD). Cases (n = 177,154) were defined as patients >18 years of age who had their first ever NIAD prescription between January 1987 and October 2013. Controls were matched by age, gender and general practitioner practice. Conditional logistic regression analyses were used to estimate the risk of NIAD prescription and use of parenteral GCs. Our analyses were statistically adjusted for lifestyle factors, comorbidities and concomitant drug use. Results: Although this study confirmed that oral GCs increases the risk of receiving a first prescription of a NIAD (OR 2.63 [95% CI 2.53–2.73]), there was no association between the use of parenterally administered GCs and the risk of receiving a first prescription of a NIAD (OR 0.88 [95% CI 0.76–1.02]). The number of GC prescriptions was not associated with risk of new onset T2DM compared to no parenteral GCs use; neither the type of GC. Conclusion: Our study does not demonstrate an association between the use of parenteral GCs and the risk of new onset of T2DM

Use of parenteral glucocorticoids and the risk of new onset type 2 diabetes mellitus : A case-control study

Background: Use of oral glucocorticoids (GCs) has been associated with hyperglycaemia and type 2 diabetes mellitus (T2DM). However, unlike oral GCs, there is minimal or no data on the effect of parenteral GC use on T2DM. Objective: To assess the association between use of parenteral GCs and the risk of receiving a first prescription of a non-insulin antidiabetic drug (NIAD) as a proxy for new onset of T2DM. Methods: A population based case-control study was performed using the Clinical Practice Research Datalink (CPRD). Cases (n = 177,154) were defined as patients >18 years of age who had their first ever NIAD prescription between January 1987 and October 2013. Controls were matched by age, gender and general practitioner practice. Conditional logistic regression analyses were used to estimate the risk of NIAD prescription and use of parenteral GCs. Our analyses were statistically adjusted for lifestyle factors, comorbidities and concomitant drug use. Results: Although this study confirmed that oral GCs increases the risk of receiving a first prescription of a NIAD (OR 2.63 [95% CI 2.53–2.73]), there was no association between the use of parenterally administered GCs and the risk of receiving a first prescription of a NIAD (OR 0.88 [95% CI 0.76–1.02]). The number of GC prescriptions was not associated with risk of new onset T2DM compared to no parenteral GCs use; neither the type of GC. Conclusion: Our study does not demonstrate an association between the use of parenteral GCs and the risk of new onset of T2DM

Severity of diabetes mellitus and risk of total hip or knee replacement: A population based case-control study

Background: It is generally thought that people with diabetes mellitus (DM) are more likely to suffer from OA due to an increased Body Mass Index (BMI), resulting in the mechanical destruction of cartilage. However, previous studies have shown that DM could also be an independent risk factor for OA, suggesting other causative factors are involved (Nieves-Plaza M, 2013; Schett G, 2013). Objectives: To evaluate the risk of hip or knee replacement, as a proxy for severe osteoarthritis (OA), in patients with diabetes mellitus (DM) compared to non-diabetic patients. We additionally evaluated the risk of total joint replacement (TJR) with various proxies for increased DM severity. Methods: We performed a population based case-control study using the Clinical Practice Research Datalink (CPRD). Cases (n=94,609) were defined as patients >18 years who had undergone TJR between 2000 and 2012. Controls were matched by age, gender and general practice. Conditional logistic regression was used to estimate the risk of total knee (TKR) and total hip replacement (THR) surgery associated with use of antidiabetic drugs (ADs). We additionally stratified current AD users by proxies for DM severity. Results: Current AD use was significantly associated with a lower risk of TKR (OR=0.86 (95% CI=0.78-0.94)) and THR (OR=0.90 (95% CI=0.82-0.99)) compared to patients not using ADs. Moreover, risk of TKR and THR was decreased with increasing HbA1c. Conclusions: In contrast to previous research, this study does not support the hypothesis that diabetic patients are more likely to suffer from severe OA as compared to non-diabetic patients. This is possibly due to methodological and medical dissimilarities between studies

Severity of diabetes mellitus and risk of total hip or knee replacement: A population based case-control study

Background: It is generally thought that people with diabetes mellitus (DM) are more likely to suffer from OA due to an increased Body Mass Index (BMI), resulting in the mechanical destruction of cartilage. However, previous studies have shown that DM could also be an independent risk factor for OA, suggesting other causative factors are involved (Nieves-Plaza M, 2013; Schett G, 2013). Objectives: To evaluate the risk of hip or knee replacement, as a proxy for severe osteoarthritis (OA), in patients with diabetes mellitus (DM) compared to non-diabetic patients. We additionally evaluated the risk of total joint replacement (TJR) with various proxies for increased DM severity. Methods: We performed a population based case-control study using the Clinical Practice Research Datalink (CPRD). Cases (n=94,609) were defined as patients >18 years who had undergone TJR between 2000 and 2012. Controls were matched by age, gender and general practice. Conditional logistic regression was used to estimate the risk of total knee (TKR) and total hip replacement (THR) surgery associated with use of antidiabetic drugs (ADs). We additionally stratified current AD users by proxies for DM severity. Results: Current AD use was significantly associated with a lower risk of TKR (OR=0.86 (95% CI=0.78-0.94)) and THR (OR=0.90 (95% CI=0.82-0.99)) compared to patients not using ADs. Moreover, risk of TKR and THR was decreased with increasing HbA1c. Conclusions: In contrast to previous research, this study does not support the hypothesis that diabetic patients are more likely to suffer from severe OA as compared to non-diabetic patients. This is possibly due to methodological and medical dissimilarities between studies

Severity of Diabetes Mellitus and Total Hip or Knee Replacement : A Population-Based Case-Control Study

It is generally thought that people with diabetes mellitus (DM) are more likely to suffer from osteoarthritis (OA) due to an increased body mass index (BMI), resulting in mechanical destruction of cartilage. However, previous studies have suggested a coexisting metabolic causality.To evaluate the risk of hip or knee replacement, as a proxy for severe OA, in patients with DM. We additionally evaluated the risk of total joint replacement (TJR) with various proxies for increased DM severity.A population-based case-control study was performed, using the Clinical Practice Research Datalink (CPRD). Cases (n = 94,609) were defined as patients >18 years who had undergone TJR between 2000 and 2012. Controls were matched by age, gender, and general practice. Conditional logistic regression was used to estimate the risk of total knee (TKR) and total hip replacement (THR) surgery associated with use of antidiabetic drugs (ADs). We additionally stratified current AD users by proxies for DM severity.Current AD use was significantly associated with a lower risk of TKR (OR = 0.86 (95% CI = 0.78-0.94)) and THR (OR = 0.90 (95% CI = 0.82-0.99)) compared to patients not using ADs. Moreover, risk of TKR and THR was decreased with increasing HbA1c.This study does not support the theory that DM patients are more likely to suffer from severe OA as compared to patients without diabetes. Moreover, risk of severe OA necessitating TJR decreases with increasing DM severity. This is possibly due to dissimilarities in methodology, a decrease in eligibility for surgery, or variability of OA phenotypes