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The prevalence of type 2 diabetes and associated risk factors with generalized osteoarthritis: a retrospective study using ICD codes for clinical data repository system

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Abstract

Objective

Type 2 diabetes mellitus (T2DM) has been associated with osteoarthritis (OA). T2DM may be associated with generalized OA (GOA ≥ 3 joints) rather than localized OA (LOA < 3 joints). The purpose of this study was to examine the prevalence of T2DM in people with GOA compared with LOA and to investigate the association between demographic risk factors and chronic diseases (i.e., T2DM, hypertension, dyslipidemia, neuropathy, and body mass index (BMI)) with GOA compared with LOA.

Methods

A retrospective review of data was performed, and patients with diagnostic codes for OA were selected. Identified codes included primary GOA, primary LOA, T2DM, hypertension, dyslipidemia, neuropathy, depression, anxiety, and sleep disorders. Information about BMI and medication list was obtained. Chi-square and logistic regression were performed to examine the prevalence and risk factors, respectively.

Results

Data from 3855 patients (mean age = 66.43 ± 11.02, 60.9% women) included patients with GOA (n = 1265) and LOA (n = 2590). The prevalence of T2DM was significantly greater among patients with GOA (25.8%) compared with those with LOA (12.0%); however, the GOA group were older. Based on age groups, T2DM was prevalent in 17.8% of GOA compared with 7.2% in LOA for younger adults (aged 45–64 years) and was prevalent in 28.8% of GOA compared with 15.7% in LOA for older adults (aged 65 years or older). The odds ratio of GOA increased in people with chronic diseases compared with those without including T2DM (odds ratio (OR) 1.37, 95% confidence interval (CI) 1.05–1.78, p = 0.02), hypertension (OR 1.99, CI 1.63–2.43, p < 0.001), and dyslipidemia (OR 3.46, CI 2.86–4.19, p < 0.001), adjusting for covariates.

Conclusion

Higher prevalence of T2DM was found in people with GOA when compared with LOA across both age groups. T2DM, hypertension, and dyslipidemia were associated with GOA. Future research with longitudinal designs is needed to test the causality of this association.

Key Points

• The prevalence of type 2 diabetes in people with generalized osteoarthritis was almost double compared with localized osteoarthritis, although generalized osteoarthritis group were older.

• Among people with osteoarthritis, the risk of generalized osteoarthritis is increased by 37% when people had type 2 diabetes, by 99% when people had hypertension, and by 246% when people had dyslipidemia.

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Data availability

The dataset generated during the current study are not publicly available due to privacy agreement but are available from the corresponding author on reasonable request.

References

  1. Litwic A, Edwards MH, Dennison EM, Cooper C (2013) Epidemiology and burden of osteoarthritis. Br Med Bull 105(1):185–199

    Article  PubMed  Google Scholar 

  2. Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, Ingelsson E, Lawlor DA, Selvin E, Stampfer M, Stehouwer CD, Lewington S, Pennells L, Thompson A, Sattar N, White IR, Ray KK, Danesh J (2010) Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 375(9733):2215–2222. https://doi.org/10.1016/s0140-6736(10)60484-9

    Article  CAS  PubMed  Google Scholar 

  3. Lawrence J (1969) Generalized osteoarthrosis in a population sample. Am J Epidemiol 90(5):381–389

    Article  CAS  PubMed  Google Scholar 

  4. Forestier R, Francon A, Briole V, Genty C, Chevalier X, Richette P (2011) Prevalence of generalized osteoarthritis in a population with knee osteoarthritis. Joint Bone Spine 78(3):275–278

    Article  PubMed  Google Scholar 

  5. Cuperus N, Vlieland TPV, Mahler EA, Kersten CC, Hoogeboom TJ, van den Ende CH (2015) The clinical burden of generalized osteoarthritis represented by self-reported health-related quality of life and activity limitations: a cross-sectional study. Rheumatol Int 35(5):871–877

    Article  CAS  PubMed  Google Scholar 

  6. Atayde SA, Yoshinari NH, Nascimento DP, Catanozi S, Andrade PC, Velosa A, Parra ER, Passarelli M, Nakandakare ER, Capelozzi VL (2012) Experimental diabetes modulates collagen remodelling of joints in rats. Histol Histopathol 27(11):1471–1479

    PubMed  Google Scholar 

  7. Courties A, Gualillo O, Berenbaum F, Sellam J (2015) Metabolic stress-induced joint inflammation and osteoarthritis. Osteoarthr Cartil 23(11):1955–1965

    Article  CAS  Google Scholar 

  8. Fan W, Song Y, Inzucchi SE, Sperling L, Cannon CP, Arnold SV, Kosiborod M, Wong ND (2019) Composite cardiovascular risk factor target achievement and its predictors in US adults with diabetes: the diabetes collaborative registry. Diabetes Obes Metab 21(5):1121–1127

    Article  CAS  PubMed  Google Scholar 

  9. Hart DJ, Doyle DV, Spector TD (1995) Association between metabolic factors and knee osteoarthritis in women: the Chingford study. J Rheumatol 22(6):1118–1123

    CAS  PubMed  Google Scholar 

  10. Kim HS, Shin JS, Lee J, Lee YJ, Kim MR, Bae YH, Park KB, Lee EJ, Kim JH, Ha IH (2016) Association between knee osteoarthritis, cardiovascular risk factors, and the Framingham risk score in South Koreans: a cross-sectional study. PLoS One 11(10):e0165325. https://doi.org/10.1371/journal.pone.0165325

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Magnusson K, Hagen KB, Osteras N, Nordsletten L, Natvig B, Haugen IK (2015) Diabetes is associated with increased hand pain in erosive hand osteoarthritis: data from a population-based study. Arthritis Care Res 67(2):187–195. https://doi.org/10.1002/acr.22460

    Article  Google Scholar 

  12. Nieves-Plaza M, Castro-Santana LE, Font YM, Mayor AM, Vila LM (2013) Association of hand or knee osteoarthritis with diabetes mellitus in a population of Hispanics from Puerto Rico. J Clin Rheumatol 19(1):1–6. https://doi.org/10.1097/RHU.0b013e31827cd578

    Article  PubMed  Google Scholar 

  13. Rahman MM, Cibere J, Anis AH, Goldsmith CH, Kopec JA (2014) Risk of type 2 diabetes among osteoarthritis patients in a prospective longitudinal study. Int J Rheumatol 2014:1–7

    Article  Google Scholar 

  14. Schett G, Kleyer A, Perricone C, Sahinbegovic E, Iagnocco A, Zwerina J, Lorenzini R, Aschenbrenner F, Berenbaum F, D’Agostino MA, Willeit J, Kiechl S (2013) Diabetes is an independent predictor for severe osteoarthritis: results from a longitudinal cohort study. Diabetes Care 36(2):403–409. https://doi.org/10.2337/dc12-0924

    Article  PubMed  PubMed Central  Google Scholar 

  15. Yoshimura N, Muraki S, Oka H, Tanaka S, Kawaguchi H, Nakamura K, Akune T (2012) Accumulation of metabolic risk factors such as overweight, hypertension, dyslipidaemia, and impaired glucose tolerance raises the risk of occurrence and progression of knee osteoarthritis: a 3-year follow-up of the ROAD study. Osteoarthr Cartil 20(11):1217–1226

    Article  CAS  Google Scholar 

  16. Eymard F, Parsons C, Edwards M, Petit-Dop F, Reginster J-Y, Bruyère O, Richette P, Cooper C, Chevalier X (2015) Diabetes is a risk factor for knee osteoarthritis progression. Osteoarthr Cartil 23(6):851–859

    Article  CAS  Google Scholar 

  17. Addimanda O, Mancarella L, Dolzani P, Ramonda R, Fioravanti A, Brusi V, Pignotti E, Meliconi R (2012) Clinical associations in patients with hand osteoarthritis. Scand J Rheumatol 41(4):310–313

    Article  CAS  PubMed  Google Scholar 

  18. Frey N, Hugle T, Jick SS, Meier CR, Spoendlin J (2016) Type II diabetes mellitus and incident osteoarthritis of the hand: a population-based case-control analysis. Osteoarthr Cartil 24(9):1535–1540. https://doi.org/10.1016/j.joca.2016.04.005

    Article  CAS  Google Scholar 

  19. Liu Y, Zhang H, Liang N, Fan W, Li J, Huang Z, Yin Z, Wu Z, Hu J (2016) Prevalence and associated factors of knee osteoarthritis in a rural Chinese adult population: an epidemiological survey. BMC Public Health 16(1):1

    Google Scholar 

  20. Garessus ED, de Mutsert R, Visser AW, Rosendaal FR, Kloppenburg M (2016) No association between impaired glucose metabolism and osteoarthritis. Osteoarthr Cartil 24(9):1541–1547. https://doi.org/10.1016/j.joca.2016.04.007

    Article  CAS  Google Scholar 

  21. Prieto-Alhambra D, Judge A, Javaid MK, Cooper C, Diez-Perez A, Arden NK (2014) Incidence and risk factors for clinically diagnosed knee, hip and hand osteoarthritis: influences of age, gender and osteoarthritis affecting other joints. Ann Rheum Dis 73(9):1659–1664. https://doi.org/10.1136/annrheumdis-2013-203355

    Article  PubMed  Google Scholar 

  22. Park J, Mendy A, Vieira ER (2018) Various types of arthritis in the United States: prevalence and age-related trends from 1999 to 2014. Am J Public Health 108(2):256–258

    Article  PubMed  PubMed Central  Google Scholar 

  23. Sanchez-Santos M, Judge A, Gulati M, Spector T, Hart D, Newton J, Arden N, Kluzek S (2018) Association of metabolic syndrome with knee and hand osteoarthritis: a community-based study of women. In: Seminars in arthritis and rheumatism. Elsevier, Amsterdam

    Google Scholar 

  24. Driban JB, Lo GH, Eaton CB, Lapane KL, Nevitt M, Harvey WF, McCulloch CE, McAlindon TE (2016) Exploratory analysis of osteoarthritis progression among medication users: data from the Osteoarthritis Initiative. Ther Adv Musculoskelet Dis 8(6):207–219

    Article  PubMed  PubMed Central  Google Scholar 

  25. Clockaerts S, Van Osch G, Bastiaansen-Jenniskens Y, Verhaar J, Van Glabbeek F, Van Meurs J, Kerkhof HJ, Hofman A, Stricker BC, Bierma-Zeinstra S (2012) Statin use is associated with reduced incidence and progression of knee osteoarthritis in the Rotterdam study. Ann Rheum Dis 71(5):642–647

    Article  CAS  PubMed  Google Scholar 

  26. Nelson AE, Smith MW, Golightly YM, Jordan JM (2014) "Generalized osteoarthritis": a systematic review. Semin Arthritis Rheum 43(6):713–720. https://doi.org/10.1016/j.semarthrit.2013.12.007

    Article  PubMed  Google Scholar 

  27. Waitman LR, Warren JJ, Manos E, Connolly DW (2011) Expressing observations from electronic medical record flowsheets in an i2b2 based clinical data repository to support research and quality improvement. In: AMIA Annu Symp Proc, pp 1454–1463

  28. Murphy SN, Weber G, Mendis M, Gainer V, Chueh HC, Churchill S, Kohane I (2010) Serving the enterprise and beyond with informatics for integrating biology and the bedside (i2b2). J Am Med Inform Assoc 17(2):124–130

    Article  PubMed  PubMed Central  Google Scholar 

  29. Shrestha S, Dave AJ, Losina E, Katz JN (2016) Diagnostic accuracy of administrative data algorithms in the diagnosis of osteoarthritis: a systematic review. BMC Med Inform Decis Mak 16(1):82

    Article  PubMed  PubMed Central  Google Scholar 

  30. Park HR, Im S, Kim H, Jung SY, Kim D, Jang EJ, Sung YK, Cho SK (2019) Validation of algorithms to identify knee osteoarthritis patients in the claims database. Int J Rheum Dis 22(5):890–896

    Article  PubMed  Google Scholar 

  31. Allen KD, Renner JB, Devellis B, Helmick CG, Jordan JM (2008) Osteoarthritis and sleep: the Johnston County osteoarthritis project. J Rheumatol 35(6):1102–1107

    PubMed  PubMed Central  Google Scholar 

  32. Sale JE, Gignac M, Hawker G (2008) The relationship between disease symptoms, life events, coping and treatment, and depression among older adults with osteoarthritis. J Rheumatol 35(2):335–342

    PubMed  Google Scholar 

  33. Axford J, Butt A, Heron C, Hammond J, Morgan J, Alavi A, Bolton J, Bland M (2010) Prevalence of anxiety and depression in osteoarthritis: use of the Hospital Anxiety and Depression Scale as a screening tool. Clin Rheumatol 29(11):1277–1283

    Article  PubMed  Google Scholar 

  34. Haberman SJ (1973) The analysis of residuals in cross-classified tables. Biometrics 29:205–220

    Article  Google Scholar 

  35. Al-Jarallah K, Shehab D, Abdella N, Al Mohamedy H, Abraham M (2016) Knee osteoarthritis in type 2 diabetes mellitus: does insulin therapy retard osteophyte formation? Med Princ Pract 25(1):12–17

    Article  PubMed  Google Scholar 

  36. Eymard F, Parsons C, Edwards MH, Petit-Dop F, Reginster J-Y, Bruyère O, Chevalier X, Cooper C, Richette P (2018) Statin use and knee osteoarthritis progression: results from a post-hoc analysis of the SEKOIA trial. Joint Bone Spine 85(5):609–614

    Article  CAS  PubMed  Google Scholar 

  37. Zhang Y-M, Wang J, Liu X-G (2017) Association between hypertension and risk of knee osteoarthritis: a meta-analysis of observational studies. Medicine (Baltimore) 96(32):e7584

    Article  Google Scholar 

  38. Sterne JA, White IR, Carlin JB, Spratt M, Royston P, Kenward MG, Wood AM, Carpenter JR (2009) Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ 338:b2393

    Article  PubMed  PubMed Central  Google Scholar 

  39. Rubin DB (2004) Multiple imputation for nonresponse in surveys, vol 81. Wiley, Hoboken

    Google Scholar 

  40. Louati K, Vidal C, Berenbaum F, Sellam J (2015) Association between diabetes mellitus and osteoarthritis: systematic literature review and meta-analysis. RMD Open 1(1):e000077

    Article  PubMed  PubMed Central  Google Scholar 

  41. Mendola ND, Chen TC, Gu Q, Eberhardt MS, Saydah S (2018) Prevalence of total, diagnosed, and undiagnosed diabetes among adults: United States, 2013-2016. NCHS Data Brief 319:1–8

    Google Scholar 

  42. Harman D (1972) The biologic clock: the mitochondria? J Am Geriatr Soc 20(4):145–147

    Article  CAS  PubMed  Google Scholar 

  43. Trounce I, Byrne E, Marzuki S (1989) Decline in skeletal muscle mitochondrial respiratory chain function: possible factor in ageing. Lancet 333(8639):637–639

    Article  Google Scholar 

  44. Srikanth VK, Fryer JL, Zhai G, Winzenberg TM, Hosmer D, Jones G (2005) A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis. Osteoarthritis Cartilage 13(9):769–781. https://doi.org/10.1016/j.joca.2005.04.014

    Article  PubMed  Google Scholar 

  45. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Despres JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jimenez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, DK MG, Mohler ER 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB (2016) Executive summary: heart disease and stroke statistics--2016 update: a report from the American Heart Association. Circulation 133(4):447–454. https://doi.org/10.1161/cir.0000000000000366

    Article  PubMed  Google Scholar 

  46. Felson DT, Zhang Y, Hannan MT, Naimark A, Weissman B, Aliabadi P, Levy D (1997) Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham study. Arthritis Rheum 40(4):728–733. https://doi.org/10.1002/1529-0131(199704)40:4<728::AID-ART19>3.0.CO;2-D

    Article  CAS  PubMed  Google Scholar 

  47. Reijman M, Pols H, Bergink A, Hazes J, Belo J, Lievense A, Bierma-Zeinstra S (2007) Body mass index associated with onset and progression of osteoarthritis of the knee but not of the hip: the Rotterdam study. Ann Rheum Dis 66(2):158–162

    Article  CAS  PubMed  Google Scholar 

  48. Williams MF, London DA, Husni EM, Navaneethan S, Kashyap SR (2016) Type 2 diabetes and osteoarthritis: a systematic review and meta-analysis. J Diabetes Complicat 30(5):944–950. https://doi.org/10.1016/j.jdiacomp.2016.02.016

    Article  Google Scholar 

  49. Dawson LP, Fairley J, Papandony M, Hussain SM, Cicuttini FM, Wluka AE (2018) Is abnormal glucose tolerance or diabetes a risk factor for knee, hip, or hand osteoarthritis? A systematic review. In: Seminars in arthritis and rheumatism. Elsevier, Amsterdam

  50. Findlay DM (2007) Vascular pathology and osteoarthritis. Rheumatology (Oxford) 46(12):1763–1768. https://doi.org/10.1093/rheumatology/kem191

    Article  CAS  Google Scholar 

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Funding

This work was financially supported by a CTSA grant from NCATS awarded to the University of Kansas for Frontiers: University of Kansas Clinical and Translational Science Institute (# UL1TR002366).

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Authors and Affiliations

  1. Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 2002, Kansas City, KS, 66160, USA

    Aqeel M. Alenazi, Shaima Alothman, Mohammed M. Alshehri, Jason Rucker, Neena K. Sharma & Patricia M. Kluding

  2. Department of Rehabilitation Sciences and Physical Therapy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia

    Aqeel M. Alenazi

  3. Department of Rehabilitation Science, Jazan University, Jazan, Saudi Arabia

    Mohammed M. Alshehri

  4. Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA

    Lemuel R. Waitman

  5. Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA

    Jo Wick

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  1. Aqeel M. Alenazi
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Contributions

All authors have made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted. Aqeel M Alenazi takes the full responsibility for this work.

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Correspondence to Aqeel M. Alenazi.

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Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration. This study received an exempt determination from the institutional review board for using de-identified data. An approval from the Data Request Oversight Committee was obtained for this analysis.

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The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or NCATS.

Additional information

Part of this work has been presented as a poster titled “The Prevalence of Diabetes and Its Association with Generalized Osteoarthritis: A Retrospective Study Using A Clinical Data Repository System” at the American Diabetes Association research symposium, Use of Real-World Data to Improve the Prevention and Care of Diabetes-Related Outcomes. Washington, D.C., USA, 16–18 November 2018.

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Alenazi, A.M., Alothman, S., Alshehri, M.M. et al. The prevalence of type 2 diabetes and associated risk factors with generalized osteoarthritis: a retrospective study using ICD codes for clinical data repository system. Clin Rheumatol 38, 3539–3547 (2019). https://doi.org/10.1007/s10067-019-04712-0

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