Impact of type 2 diabetes mellitus on interstitial lung disease risk in rheumatoid arthritis

doi:10.12998/wjcc.v13.i33.110641

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 13, Issue 33

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Supplementary Materials of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (329)

All Articles published online

The chart showing PDF series, HTML series, Figures (1-1) series, Tables (1-5) series.

Item

Count

PDF

HTML

141

Figures (1-1)

Tables (1-5)

Sum=185

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

Download

102

Sum=128

Nov 26, 2025 (publication date) through Jan 9, 2026

Times Cited of This Article

Times Cited (1)

Journal Information of This Article

Publication Name

World Journal of Clinical Cases

ISSN

2307-8960

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Clin Cases. Nov 26, 2025; 13(33): 110641
Published online Nov 26, 2025. doi: 10.12998/wjcc.v13.i33.110641

Impact of type 2 diabetes mellitus on interstitial lung disease risk in rheumatoid arthritis

Jacob Sutton, Georges Khattar, Fares Saliba, Omar Mourad, Laurence Aoun, Jennifer Jdaidani, Hamza Qandil, Chris Kaspar, Saif Abu-Baker, Shaza Almardini, Fadi Haddadin, Elie Bou Sanayeh, Anastasia Slobodnick

Jacob Sutton, Georges Khattar, Fares Saliba, Omar Mourad, Laurence Aoun, Jennifer Jdaidani, Hamza Qandil, Chris Kaspar, Saif Abu-Baker, Shaza Almardini, Fadi Haddadin, Elie Bou Sanayeh, Department of Internal Medicine, Staten Island University Hospital-Northwell Health, Staten Island, NY 10305, United States

Anastasia Slobodnick, Department of Rheumatology, Staten Island University Hospital-Northwell Health, Staten Island, NY 10305, United States

Co-first authors: Jacob Sutton and Georges Khattar.

Author contributions: Sutton J, Khattar G designed the study concept and methodology; Mourad O, Saliba F, Jdaidani J, Khattar G collected and analyzed the data; Khattar G, Jdaidani J, Aoun L, Abu-Baker S, Almardini S, Haddadin F, Bou Sanayeh E, Qandil H, Kaspar C contributed to writing the manuscript and revising it critically; Slobodnick A, Khattar G, Mourad O, Saliba F provided important intellectual content and final clinical interpretation; all authors have read and approved the final manuscript.

Institutional review board statement: This study was exempt from IRB approval as it utilized publicly available, de-identified data from the National Inpatient Sample, in accordance with guidelines for research not involving human subjects.

Informed consent statement: Informed consent was not required for this study, as it involved analysis of de-identified, publicly available data from the National Inpatient Sample. No individual patient information was accessed. All investigators have reviewed and approved the use of this dataset and the conduct of this study in accordance with ethical standards.

Conflict-of-interest statement: The authors declare that they have no conflicts of interest related to this study.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.

Data sharing statement: The data used in this study are publicly available through the Healthcare Cost and Utilization Project National Inpatient Sample database. Access to the National Inpatient Sample requires registration and compliance with Healthcare Cost and Utilization Project data use agreements.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Jacob Sutton, MD, Department of Internal Medicine, Staten Island University Hospital-Northwell Health, 475 Seaview Avenue, Staten Island, NY 10305, United States. jsutton2@northwell.edu

Received: June 11, 2025
Revised: June 26, 2025
Accepted: October 22, 2025
Published online: November 26, 2025
Processing time: 163 Days and 6.1 Hours

Abstract

BACKGROUND

This study investigates the impact of type 2 diabetes mellitus (T2DM) on the risk of interstitial lung disease (ILD) and its subtypes in patients with rheumatoid arthritis (RA). RA is often complicated by ILD. T2DM has systemic proinflammatory effects, but its impact on RA-related ILD is unclear. This research aims to elucidate the interplay between these conditions to inform clinical management and patient care strategies.

AIM

To determine if RA patients with T2DM have a higher occurrence of ILD compared to RA patients without T2DM.

METHODS

We conducted a retrospective cohort study using the 2019-2020 National Inpatient Sample. Adult RA patients with and without T2DM were identified via International Classification of Diseases, 10^th Revision (ICD-10) codes. Propensity score matching (1:1) balanced 15+ confounders. Logistic regression assessed the association of T2DM with ILD (overall and by subtype) and secondary outcomes (acute respiratory distress syndrome, pneumothorax, pleural effusion, pulmonary hypertension). Missing data were excluded. ILD subtypes were included based on ICD-10 codes and case count.

RESULTS

Among 199380 RA inpatients, ILD was more common in those with T2DM (2.25%) vs without (1.11%). After matching (n = 121046), ILD remained higher in RA + T2DM [odds ratio (OR) = 2.02, 95%CI: 1.84-2.22, P < 0.001], with an absolute risk increase of about 1.14%. T2DM was associated with higher odds of ILD subtypes including usual interstitial pneumonia (OR = 3.20) and non-specific interstitial pneumonia (OR = 3.50). Other subtypes showed elevated ORs; eosinophilic pneumonia showed an inverse association (OR = 0.23). PAH and pneumothorax were also more common in RA + T2DM (OR = 1.40 and 1.85, respectively). Acute respiratory distress syndrome and pleural effusion rates did not differ by T2DM status. Rare subtype findings should be interpreted cautiously.

CONCLUSION

T2DM increases ILD risk in RA and is linked to higher rates of pulmonary hypertension and pneumothorax, suggesting a role in exacerbating RA-related lung complications.

Keywords: Rheumatoid arthritis; Diabetes mellitus; Interstitial lung disease; Pulmonary hypertension; Pulmonary fibrosis

Core Tip: In this large inpatient study, we found that rheumatoid arthritis (RA) patients with type 2 diabetes have about twice the odds of developing interstitial lung disease compared to those without diabetes. This novel association remained significant after adjusting for numerous confounders. Diabetic RA patients also showed more pulmonary hypertension and pneumothorax. These results highlight the “diabetic lung” as a potential new consideration in RA care. Clinicians should be aware that co-morbid diabetes might heighten pulmonary risks in RA, although prospective studies are needed to confirm if controlling diabetes can improve lung outcomes.