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Diabetes occurs when the body is unable to produce or use the hormone insulin sufficiently. Insulin converts the sugars we get from food into energy. Like rheumatoid arthritis (RA), diabetes is an autoimmune disease. In the case of diabetes, the body’s immune system attacks the cells of the pancreas that make insulin.
Of the 52 million adults with arthritis in the U.S., 16 percent have type 2 diabetes, and 47 percent of adults with diabetes have arthritis. We know that people with diabetes are nearly twice as likely to have arthritis, but why? Research suggests a link between diabetes and arthritis, though the specific nature of this connection is unclear.
One theory suggests that the ongoing inflammation that is a hallmark of RA may play a role in the development of diabetes. This is because of the known link between inflammation and an increased risk of insulin resistance. Indeed, insulin resistance does tend to be elevated in RA, and levels of inflammatory markers tend to be high both in people with RA and people with diabetes. Another theory is that people with RA and other forms of arthritis tend to be more sedentary (and a sedentary lifestyle leads to obesity, a known risk factor for diabetes). If true, this could explain the increased risk of diabetes among people with arthritis.
One of the medications often used for arthritis could also play a role, as it is well known that steroids can increase the risk of diabetes. However, studies show that other RA drugs may actually lower diabetes risk: the antimalarial drug hydroxychloroquine, which is typically used to treat mild RA, is associated with a lower risk of diabetes among people with RA, though it’s unclear why this is so. Other RA drugs known as TNF blockers and methotrexate have been shown to improve insulin resistance and lower diabetes risk, but more research is needed.
For people with RA who may be concerned about diabetes, it is important to maintain a healthy lifestyle. This includes exercise, eating a healthy diet that contains some protein, healthy fats, whole grains and non-starchy vegetables, maintaining a healthy weight, and not smoking. These choices not only help manage RA; they also are important to reduce your risk of diabetes.