{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T22:07:30Z","timestamp":1782511650272,"version":"3.54.5"},"reference-count":30,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2023,7,17]],"date-time":"2023-07-17T00:00:00Z","timestamp":1689552000000},"content-version":"unspecified","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2023,6,25]]},"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Patients with rheumatoid arthritis are prone to developing diabetes, which may lead to various sequelae and even cardiovascular diseases, the most common cause of death in such patients. Previous research has shown that some rheumatoid arthritis treatments may help prevent the development of diabetes. This study aimed to investigate whether patients using disease-modifying anti-rheumatic drugs (DMARDs) may have different levels of risk for diabetes and to analyse other risk factors for diabetes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This cohort study used data from the Chang Gung Research Database. 5530 adults with rheumatoid arthritis but without diabetes were eligible for the analysis. The endpoint of this study was new-onset diabetes, defined as an HbA1c value \u22657% during follow-up. The entire follow-up period was divided into monthly subunits. These 1-month units were then divided into methotrexate (MTX) monotherapy, any biological DMARDs (bDMARDs), MTX combination, other conventional DMARDs (cDMARDs) and non-DMARDs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 546 participants (9.87%) developed diabetes between 2001 and 2018. The risk of diabetes was significantly lower in the bDMARD periods (HR 0.51; 95% CI 0.32 to 0.83), MTX combination periods (HR 0.50; 95%\u2009CI 0.32 to 0.78) and other cDMARD periods (HR 0.56; 95%\u2009CI 0.37 to 0.84) than in the MTX monotherapy periods. Individual drug analysis showed that hydroxychloroquine (HR 0.52; 95%\u2009CI 0.42 to 0.65) reduced the risk of diabetes. Tumour necrosis factor-\u03b1 inhibitors (HR 0.69; 95%\u2009CI 0.46 to 1.03) tended to be protective.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Patients with rheumatoid arthritis may have different levels of risk of diabetes depending on the treatment options.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2023-003045","type":"journal-article","created":{"date-parts":[[2023,7,17]],"date-time":"2023-07-17T21:11:12Z","timestamp":1689628272000},"page":"e003045","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Disease-modifying anti-rheumatic drugs associated with different diabetes risks in patients with rheumatoid arthritis"],"prefix":"10.1136","volume":"9","author":[{"given":"Yu-Jih","family":"Su","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan"},{"name":"School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, R O C"},{"name":"Institute of Biopharmaceutical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan, R O C"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui-Ming","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Occupational Medicine, Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0753-4529","authenticated-orcid":false,"given":"Tien-Ming","family":"Chan","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung University and Chang Gung Memorial Hospital, Tao-Yuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tien-Tsai","family":"Cheng","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan"},{"name":"School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, R O C"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan-Fu","family":"Yu","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan"},{"name":"School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, R O C"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia-Feng","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan"},{"name":"School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, R O C"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2273-7877","authenticated-orcid":false,"given":"Chun-Yu","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan"},{"name":"Department of Health Business Administration, Fooyin University, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1207-646X","authenticated-orcid":false,"given":"Chung-Yuan","family":"Hsu","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan"},{"name":"School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, R O C"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,7,17]]},"reference":[{"key":"2025090312351350000_9.3.e003045.1","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.109.190108"},{"key":"2025090312351350000_9.3.e003045.2","doi-asserted-by":"publisher","DOI":"10.1002\/art.24836"},{"key":"2025090312351350000_9.3.e003045.3","doi-asserted-by":"crossref","unstructured":"Innala L , M\u00f6ller B , Ljung L , et al . 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