The impact of hip and knee osteoarthritis on the subsequent risk of incident diabetes: a population-based cohort study
This study examined the relationship between hip/knee osteoarthritis and incident diabetes. We hypothesised that hip/knee osteoarthritis would be independently related to an increased risk of incident diabetes and that this relationship would be due, at least in part, to walking difficulty. We also hypothesised a stronger relationship with incident diabetes for knee than hip osteoarthritis because of the higher prevalence in the former of obesity/the metabolic syndrome.
A population cohort aged ≥55 years recruited from 1996 to 1998 was followed through provincial health administrative data to 2014. Participants with baseline diabetes were excluded. Hip/knee osteoarthritis was defined as swelling, pain or stiffness in any joint lasting 6 weeks in the past 3 months and indication on a joint homunculus that a hip/knee was ‘troublesome’. Walking limitation was defined as self-reported difficulty standing or walking in the last 3 months (yes/no). Using Cox regressions, we examined the relationship of baseline hip/knee osteoarthritis with incident diabetes as defined from health administrative data, controlling for age, sex, BMI, income, prior hypertension, cardiovascular disease and primary care exposure. We tested whether the observed effect was mediated through walking limitation.
In total, 16,362 participants were included: median age 68 years and 61% female. Of these, 1637 (10%) individuals met the criteria for hip osteoarthritis, 2431 (15%) for knee osteoarthritis and 3908 (24%) for walking limitation. Over a median follow-up of 13.5 years (interquartile range 7.3–17.8), 3539 individuals (22%) developed diabetes. Controlling for confounders, a significant relationship was observed between number of hip/knee joints with osteoarthritis and incident diabetes: HR for two vs no osteoarthritic hips 1.25 (95% CI 1.08, 1.44); HR for two vs no osteoarthritic knees 1.16 (95% CI 1.04, 1.29). From 37% to 46% of this relationship was explained by baseline walking limitation.
In a large population cohort aged ≥55 years who were free of diabetes at baseline, and controlling for confounders, the presence and burden of hip/knee osteoarthritis was a significant independent predictor of incident diabetes. This association was partially explained by walking limitation. Increased attention to osteoarthritis and osteoarthritis-related functional limitations has the potential to reduce diabetes risk.
KeywordsHip and knee osteoarthritis Incident diabetes Population cohort Walking limitation
American College of Rheumatology
Johns Hopkins’ Aggregated Diagnosis Group
Unique health card number
Institute for Clinical Evaluative Sciences
Ontario Diabetes Database
The authors thank A. Wall (Department of Medicine, Women’s College Hospital, Canada) for her substantial role in cohort recruitment and project management. We also express our sincere thanks to all participants in the Ontario Hip and Knee Cohort, without whom this research could not have taken place. We thank IMS Brogan for use of their drug information database.
The severity of comorbidities at baseline was approximated using an aggregated score, the Johns Hopkins’ Aggregated Diagnosis Groups categories (The Johns Hopkins ACG® System, Version 10).
Some of the data were presented as an oral presentation at the 2016 ACR/Association of Rheumatology Health Professionals (ARHP) Annual Meeting (Washington, DC, 12-16 November 2016) and the 2017 Canadian Rheumatology Association (CRA) Annual Scientific Meeting & Arthritis Health Professions Association (AHPA) Annual Meeting (Ottawa, ON, Canada, 8-11 February 2017).
All authors contributed to study design and interpretation of data. TK, RC and GAH were responsible for the statistical analysis. TK and GAH drafted the manuscript. All authors critically revised the manuscript for important intellectual content, read and approved the final manuscript and approved the decision to submit for publication. TK and GAH are the guarantors and had full access to all of the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis.
This study was funded by an operating grant from the Canadian Institutes of Health Research (grant #MOP-15468). The study was also supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). No endorsement by ICES or the Ontario MOHLTC is intended nor should be inferred. ICES had no role in the: design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; or decision to submit the report for publication. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources and CIHI.
Duality of interest
GAH has received research support as the Sir John and Lady Eaton Professor and Chair of Medicine, Department of Medicine, University of Toronto. All other authors declare that there is no duality of interest associated with this manuscript.
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