Impact of Type 2 Diabetes on Clinical Outcomes and Advanced Therapy Use in Patients with Crohn’s Disease: a Real-World Propensity Score-Matched Analysis

Background Type 2 diabetes mellitus (T2DM) may adversely affect the course and treatment outcomes of Crohn’s disease (CD). However, data remain inconsistent. Aims To evaluate the impact of T2DM on clinical outcomes and advanced therapy use in patients with CD using real-world electronic health record data. Methods We conducted a retrospective cohort study using the TriNetX Global Collaborative Network. Adult patients with CD were stratified by the presence of T2DM. Propensity score matching was used to balance demographic and clinical characteristics. Primary outcomes included corticosteroid use, abdominal surgery, drug-related adverse events, and the initiation of advanced therapies. Secondary outcomes included the incidence of neoplasms and mental disorders. Time-to-event outcomes were analyzed using Kaplan–Meier curves and hazard ratios. Results After matching, 7,182 patients were included in each cohort. Corticosteroid use was higher in diabetic patients (61.6% vs 55.2%; p < 0.001), as were abdominal surgery (32.8% vs 31.1%; p = 0.010) and drug-related adverse events (4.3% vs 2.4%; p < 0.001). Anti–TNF (10.4% vs 12.2%; p < 0.001) and IL-23 inhibitors (4.6% vs 5.4%; p = 0.018) use was lower in diabetic patients. Use of vedolizumab (2.4% vs 2.6%; p = 0.401) and JAK inhibitors (0.6% in both; p = 0.955) was similar. Neoplasm rates were comparable (3.5% vs 3.2%; p = 0.386), while mental disorders were more common in the diabetic cohort (51.5% vs 41.2%; p < 0.001). Conclusions Patients with CD and coexisting T2DM experience a more severe disease course yet appear to be undertreated with advanced therapies. These findings highlight the need for tailored, multidisciplinary management strategies in this high-risk population.