{
  "abstract": "Introduction Patients with systemic sclerosis (SSc) exhibit a high risk of microvascular damage leading to multiple and severe complications. Diabetes mellitus (DM) is also characterized by widespread micro-angiopathy. Both conditions may be associated with macro-angiopathy and related cardiovascular events. Few studies have investigated DM in SSc, and some have suggested a lower prevalence. The present study aimed to assess the prevalence of DM in a multicenter SSc cohort and explore its association with patient outcomes, particularly cardiovascular burden.Material and Methods We identified 3,260 SSc patients from 9 tertiary rheumatology centers (Portugal, France and Italy). Patients taking oral antidiabetic drugs or insulin were classified as having DM, regardless of subtype. Given the strong influence of age on DM risk, each SSc patient with DM was matched to three SSc patients without DM based on age at last visit (±5 years). Demographic, socioeconomic, and disease-related characteristics were compared between groups at last follow-up. Continuous variables were reported as mean (standard deviation, SD) or median [interquartile range, IQR], as appropriate.Results DM was identified in 109 patients, representing a prevalence of 3.3%. Median age was 71.0 [15.0] years in the DM group and 71.0 [16.0] in the matched control group (n=327). SSc patients with DM were more often of non-Caucasian ethnicity (13.0% vs 9.0%, p<0.001), had longer median disease duration (12.1 [14.1] vs 6.7 [8.2] years, p=0.006), more frequent joint involvement (13.8% vs 5.5%, p=0.004), and were more frequently treated with corticosteroids (33.0% vs 23.5%, p=0.001). Prevalence of interstitial lung disease and mean FVC%, and DLCO% were similar between groups, but mean TLC% (total lung capacity) was lower in the DM group (83.5% (16.1%) vs 91.6% (19.9%), p=0.027). Telangiectasia, subcutaneous calcinosis and gastrointestinal manifestations were less common in the SSc-DM group. Furthermore, there were no significant differences in the occurrence of digital ulcers, scleroderma renal crisis, pulmonary hypertension, diffuse cutaneous involvement, and autoantibody profile.In multivariate analysis adjusted for disease duration, sex, ethnicity and steroid use, low TLC remained independently associated with DM (OR: 1.13; 95% CI: 1.01-1.22).We observed a lower crude mortality rate in the DM group (15.6% vs 32.4%, p<0.001); however, this difference was not confirmed in time-to-event analyses (HR 1.19; 95% CI 0.32–4.47).Conclusions The herein results support a low prevalence of diabetes in SSc. Contrary to our initial hypothesis, cardiovascular burden was not increased in SSc-DM patients and, unexpectedly, these patients appear to have a milder phenotype rather than more severe disease.",
  "authors": [
    {
      "affiliations": [
        "Rheumatology Department, Hospital de Santa Maria, U.L.S. Santa Maria, Lisbon, Portugal"
      ],
      "name": "Gonçalo Boleto"
    },
    {
      "affiliations": [
        "Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR) San Raffaele Scientific Institute, Milan, Italy"
      ],
      "name": "Corrado Campochiaro"
    },
    {
      "affiliations": [
        "Scleroderma Unit, Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia, Brescia, Italy"
      ],
      "name": "Paolo Airó"
    },
    {
      "affiliations": [
        "Scleroderma Unit, Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia, Brescia, Italy"
      ],
      "name": "Maria-Grazia Lazzaroni"
    },
    {
      "affiliations": [
        "Scleroderma Unit, Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia, Brescia, Italy"
      ],
      "name": "Liala Moschetti"
    },
    {
      "affiliations": [
        "Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy"
      ],
      "name": "Elisabetta Zanatta"
    },
    {
      "affiliations": [
        "Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy"
      ],
      "name": "Andrea Benini"
    },
    {
      "affiliations": [
        "Department of Clinical and Molecular Sciences, Marche Polytechnic University & Clinica Medica, Ancona, Italy"
      ],
      "name": "Gianluca Moroncini"
    },
    {
      "affiliations": [
        "Department of Clinical and Molecular Sciences, Marche Polytechnic University & Clinica Medica, Ancona, Italy"
      ],
      "name": "Devis Benfaremo"
    },
    {
      "affiliations": [
        "CHU de Bordeaux, Rheumatology Department, Bordeaux, France"
      ],
      "name": "Marie-Élise Truchetet"
    },
    {
      "affiliations": [
        "CHU de Bordeaux, Rheumatology Department, Bordeaux, France"
      ],
      "name": "Louis Bébéar"
    },
    {
      "affiliations": [
        "Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy"
      ],
      "name": "Silvia Bellando Randone"
    },
    {
      "affiliations": [
        "Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy"
      ],
      "name": "Serena Guiducci"
    },
    {
      "affiliations": [
        "Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France"
      ],
      "name": "Alain Lescoat"
    },
    {
      "affiliations": [
        "Rheumatology Unit, Department of Precision and Regenerative Medicine-Ionian Area, University of Bari Aldo Moro, Bari, Italy"
      ],
      "name": "Fabio Cacciapaglia"
    },
    {
      "affiliations": [
        "Scleroderma Clinic, UOC Clinica Reumatologica, ASST Pini-CTO, Università degli Studi di Milano, Milan, Italy"
      ],
      "name": "Nicoletta Del Papa"
    },
    {
      "affiliations": [
        "Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR) San Raffaele Scientific Institute, Milan, Italy"
      ],
      "name": "Marco Matucci-Cerinic"
    },
    {
      "affiliations": [
        "Université Paris Cité, AP-HP, Hôpital Cochin, Rheumatology, Paris, France"
      ],
      "name": "Yannick Allanore"
    }
  ],
  "title": "P.411 Phenotypic impact of diabetes mellitus on the course of systemic sclerosis: insights from an international multicenter study",
  "uid": "65494dc5-8552-517a-a464-2cb48a4b412d"
}