TOPLINE:

Patients with Crohn's disease and type 2 diabetes (T2D) had an increased use of corticosteroids, higher incidence of abdominal surgery, and decreased utilisation of certain advanced therapies compared with those with Crohn's disease alone.

METHODOLOGY:

• Researchers conducted a retrospective observational study using the TriNetX Global database to assess whether T2D affects key clinical outcomes in patients with Crohn's disease.
• Two cohorts were analysed after propensity score matching, which included 7182 patients with Crohn's disease and T2D (70.1% White) and an equal number of patients with Crohn's disease alone (71.8% White).
• Primary outcomes were the use of systemic corticosteroids, abdominal surgery, and the occurrence of drug-related adverse events, which were compared between patients with T2D and Crohn's disease and those with Crohn's disease alone, assessed over a follow-up duration of up to 5 years.
• Secondary outcomes included the initiation of advanced therapies and the risk of developing neoplasms and mental, behavioural, or neurodevelopmental disorders.

TAKEAWAY:

• During follow-up, 61.6% of patients with Crohn's disease and T2D vs 55.2% of those with Crohn's disease alone received corticosteroids (risk ratio [RR], 1.12; 95% CI, 1.09-1.15). Those with Crohn's disease and T2D also had an earlier median time to first corticosteroid use than those with Crohn's disease alone (674 vs 967 days).
• Patients with Crohn's disease and T2D had a higher incidence of abdominal surgery (RR, 1.06; 95% CI, 1.01-1.11) and drug-related adverse events (RR, 1.80; 95% CI, 1.50-2.17) than those with Crohn's disease alone.
• Researchers found a lower utilisation of interleukin-23 inhibitors in the Crohn's disease plus T2D group, with a lower likelihood of initiating anti-TNF therapy; however, no significant differences in the use of vedolizumab and JAK inhibitors were observed between the groups.
• Patients with Crohn's disease and T2D had more prevalent mental, behavioural, and neurodevelopmental disorders than those with Crohn's disease alone; however, the occurrence of neoplasms remained comparable between the cohorts.

IN PRACTICE:

"The analysis focused not only on effectiveness outcomes but also included safety signals and treatment access patterns, offering a holistic view of how metabolic comorbidity may shape clinical management in routine practice," the authors of the study wrote.

SOURCE:

This study was led by Sara Massironi, MD, PhD, Vita-Salute San Raffaele University, Medicine and Surgery, Milan, Italy. It was published online on August 21, 2025, in the Journal of Crohn's and Colitis.

LIMITATIONS:

Clinical measures of disease activity, including the Crohn's Disease Activity Index, endoscopic severity, and histology, were not recorded in the database. Although laboratory markers were used as proxies for disease activity, residual confounding cannot be excluded. Likewise, steroid-induced diabetes could not be entirely ruled out. Finally, information on adherence to medication and over-the-counter drug use was not consistently available.

DISCLOSURES:

This study did not receive any specific funding. Several authors reported receiving personal, speaker, lecture, and consulting/advisory board fees from various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.