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What is the absolute risk of developing diabetes mellitus in patients with glucocorticoid-treated polymyalgia rheumatica and giant cell arteritis? a systematic review and meta-analysis

机译：糖皮质激素治疗的风湿性多肌痛和巨细胞动脉炎患者发生糖尿病的绝对风险是什么？系统评价和荟萃分析

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Background: Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are treated with glucocorticoids (GCs) but long-term GC use is associated with diabetes mellitus (DM). The absolute incidence of this serious complication in this patient group remains unclear.udududObjectives: To quantify the absolute risk of GC-induced DM in PMR and GCA in published literature.udududMethods: We identified literature from inception to February 2016 reporting diabetes following exposure to oral GC in patients with PMR and/or GCA without preexisting diabetes. A random-effects meta-analysis was performed to summarise the literature. Risk of bias was assessed using the Cochrane Collaboration tool.udududResults: 21 eligible publications were identified. In studies of patients with GCA, mean cumulative GC dose was almost two times higher than in studies of PMR (8.9g vs 5.0g), with slightly longer treatment duration but much longer duration of follow-up (8.8years vs 4.4years). The incidence proportion (cumulative incidence) of patients who developed new-onset DM was 6% (95% CI: 3–9%) for PMR and 12% (95% CI: 8–17%) for GCA. Heterogeneity between studies was high (I2=78.2%), as there were differences in study designs, patient population, geographical locations and treatment strategies. Based on UK data on incidence rate of DM in the general population1, the expected background incidence rate of DM over 4.4 years in PMR patients and 8.8 years in GCA patients (the duration of follow-up) would be 4.8% and 9.7%, respectively. Very little information on predictors of DM in PMR or GCA patients was found. The overall risk of bias was high for many of the observational studies, especially relating to definition and recording of outcome and prognostic variables.udududConclusions: Physicians should screen patients treated for PMR/GCA for DM but it remains unclear what is the time-period of greatest risk and the influence of risk factors. Our meta-analysis produced plausible estimates of DM incidence in patients with PMR and GCA but there is insufficient published data to allow precise quantification of the DM risk or, crucially, which patients are at greatest risk
机译：背景：风湿性多肌痛（PMR）和巨细胞动脉炎（GCA）用糖皮质激素（GCs）治疗，但长期使用GC与糖尿病（DM）有关。 ud ud ud目的：为了量化已发表文献中PMR和GCA中GC诱发DM的绝对风险。 ud ud ud方法：我们从始于2016年2月的研究报告，未患有糖尿病的PMR和/或GCA患者接受口服GC治疗后出现糖尿病。进行了随机效应荟萃分析以总结文献。使用Cochrane协作工具评估了偏见风险。 ud ud ud结果：确定了21篇合格出版物。在GCA患者的研究中，平均累积GC剂量几乎是PMR研究的两倍（8.9g vs 5.0g），治疗时间略长，但随访时间更长（8.8年vs 4.4年）。发生新发DM的患者的PMR发生率（累积发生率）为6％（95％CI：3–9％），GCA为12％（95％CI：8–17％）。研究之间的异质性很高（I2 = 78.2％），因为研究设计，患者人群，地理位置和治疗策略存在差异。根据英国有关普通人群DM发生率的数据1，PMR患者4.4年和GCA患者8.8年（随访持续时间）的DM预期背景发生率分别为4.8％和9.7％。 。很少有关于PMR或GCA患者DM预测因子的信息。许多观察性研究的总体偏倚风险很高，特别是与结果的定义和记录以及预后变量有关。 ud ud ud结论：医师应筛查接受PMR / GCA治疗的DM患者，但尚不清楚最大风险的时间段和风险因素的影响。我们的荟萃分析对PMR和GCA患者的DM发生率进行了合理的估计，但尚无足够公开的数据来准确量化DM风险，或者至关重要的是，哪些患者处于最大风险

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