MedWire News: Crohn's disease patients with diabetes are more than six times more likely to require surgery than patients without the condition, reveals research published in the journal Alimentary Pharmacology and Therapeutics.
"Although further studies are necessary to understand this relationship, this represents an inexpensive and readily available clinical marker that warrants increased attention in all [inflammatory bowel disease] patients," comment Jason Harper and co-authors, from the University of Washington in Seattle, USA.
The team examined for 5-year clinical predictors for Crohn's disease-specific surgical intervention in 240 patients with biopsy confirmation of Crohn's disease who had been diagnosed at least 4.5 years earlier.
Sixteen (6.6%) of the patients were diagnosed with diabetes before the study began in 2004, including eight patients who had diabetes associated with use of corticosteroids or total parenteral nutrition.
Patients with diabetes were significantly older than controls (47.4 vs 38.6 years) and significantly more likely to be obese than (44 vs 10%). But patients with and without diabetes did not significantly differ with regard to smoking, diagnosis of perianal or ileal disease, or use of IBD biologic agents, immunomodulators or corticosteroids.
Over 5 years, 12 patients with diabetes and 71 controls underwent Crohn's disease-specific surgery, such as small bowel resection, abscess drainage, or fistula repair.
Initial analysis demonstrated that surgical intervention was significantly predicted by diabetes (odds ratio [OR]=6.46), smoking (OR=2.46), ileal disease (OR=2.21), and obesity (OR=2.22).
After adjusting for confounding factors, including gender, age, and pharmacological treatment received, and including only the idiopathic diabetes patients, the only remaining risk factors to significantly predict surgery in patients with Crohn's disease were idiopathic diabetes (OR=5.4) and smoking (OR=2.22).
When including both idiopathic and treatment-related diabetes patients, the adjusted OR for surgery was 4.65.
The researchers note that Short Inflammatory Bowel Disease Questionnaire scores showed that patients with diabetes also had significantly poorer quality of life, indicating more severe disease activity, than patients without the comorbidity.
Discussing the care of individuals with both Crohn's disease and diabetes, Harper et al recommend: "This group of patients may benefit from early combination or biologic therapy, and treating physicians should consider this factor when assessing which therapies would be most appropriate for patients with Crohn's disease."
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