ECTS Abstracts (2015) 1 P2

Severity of diabetes mellitus and risk of total hip or knee replacement: a population based case-control study

Johannes Nielen1,5, Andrea Burden6,8, Bart van den Bemt2,3, Arief Lalmohamed1,9, Anthonius de Boer1, Annelies Boonen4, Pieter C Dagnelie5, Pieter Emans7 & Frank de Vries1,6


1Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands; 2Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands; 3Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands; 4Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands; 5Department of Epidemiology, Maastricht University, Maastricht, The Netherlands; 6Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, Maastricht, The Netherlands; 7Department of Orthopaedics, Maastricht University Medical Center, Maastricht, The Netherlands; 8School Caphri, Maastricht University, Maastricht, The Netherlands; 9Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.


Background: The aim of this study was to evaluate the risk of hip or knee replacement, as a proxy for severe osteoarthritis (OA), in patients with diabetes mellitus (DM). We additionally evaluated the risk of total joint replacement (TJR) with various proxies for increased DM severity.

Methods: We performed a population based case-control study using the Clinical Practice Research Datalink (CPRD). Cases (n=94,609) were defined as patients >18 years who had undergone TJR between 2000 and 2012. Controls were matched by age, gender and general practitioner (GP) practice. Conditional logistic regression was used to estimate the risk of total knee (TKR) and total hip replacement (THR) surgery associated with use of antidiabetic drugs (ADs). We additionally stratified current AD users by proxies for OA severity.

Results: Current AD use was significantly associated with a lower risk of TKR (OR=0.86 [95% CI=0.78-0.94]) and THR (OR=0.90 [95% CI=0.82-0.99]) compared with patients not using ADs. Moreover, risk of TKR and THR was decreased with increasing HbA1c.

Conclusions: Contrary to previous research, our study suggests that DM patients are less likely to suffer from severe OA as compared to non-users. Moreover, risk of severe OA necessitating TJR decreases with increasing DM severity, based on HbA1c values. This is possibly due to dissimilarities in methodology, a decrease in eligibility for surgery, or variability of OA phenotypes.

Disclosure: The authors declared no competing interests.

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