Contributing factors of diabetes mellitus among patients with gout (results of the long-term prospective study)

Abstract

It is assumed that the risk of developing type 2 diabetes mellitus (T2DM) in patients with gout is influenced by both generally accepted risk factors and factors related to gout.Objective. To evaluate the impact of various risk factors for T2DM in patients with gout.Material and methods. 444 patients (49 women, 395 men) ≥18 years old with gout and without DM were included. Duration of observation was 5.66 [2.69; 7.64] g. To identify factors associated with the risk of developing T2DM, multivariate logistic regression was used, which included: sex; T2DM in relatives; insufficient physical activity; unbalanced diet; age ≥45 years; ≥4 attacks per year; presence of tophi; BMI≥30 kg/m2 ; allopurinol, febuxostat, glucocorticoids, diuretics, metformin, colchicine; GFR<60 ml/min/1.73 m2 ; serum uric acid level (sUA) ≥420 μmol/l and ≥480 μmol/l. Results. T2DM developed in 108 (24.3%) patients. According to the multivariate model, the presence of ≥4 attacks of arthritis per year increased the risk of T2DM (OR=5.23; 95% CI: 2.98–9.19; p=0.0001); presence of tophi (OR=2.61; 95% CI: 1.50–4.54; p=0.001); sUA≥480 μmol/l (OR=2.26; 95% CI: 1.02–5.00; p=0.144), diuretics (OR=2.35; 95% CI: 1.19–4.64; p=0.014). Febuxostat (OR=0.31; 95% CI: 0.11–0.84; p=0.022) and metformin (OR=0.49; 95% CI: 0.21–1.16; p=0.107) reduced the risk of developing T2DM. Conclusion. Risk of T2DM in patients with gout is associated with high incidence of arthritis attacks, MK≥480 μmol/l, hypertension, diuretic use, and febuxostat and metformin reduces risk. Key words: gout, type 2 diabetes mellitus, uric acid>˂ 60 ml/min/1.73 m2 ; serum uric acid level (sUA) ≥420 μmol/l and ≥480 μmol/l.Results. T2DM developed in 108 (24.3%) patients. According to the multivariate model, the presence of ≥4 attacks of arthritis per year increased the risk of T2DM (OR=5.23; 95% CI: 2.98–9.19; p=0.0001); presence of tophi (OR=2.61; 95% CI: 1.50–4.54; p=0.001); sUA≥480 μmol/l (OR=2.26; 95% CI: 1.02–5.00; p=0.144), diuretics (OR=2.35; 95% CI: 1.19–4.64; p=0.014). Febuxostat (OR=0.31; 95% CI: 0.11–0.84; p=0.022) and metformin (OR=0.49; 95% CI: 0.21–1.16; p=0.107) reduced the risk of developing T2DM.Conclusion. Risk of T2DM in patients with gout is associated with high incidence of arthritis attacks, MK≥480 μmol/l, hypertension, diuretic use, and febuxostat and metformin reduces risk.

Consensus statement on the management of patients with asymptomatic hyperuricemia in general medical practice

“…Наконец, по данным крупного проспективного 6-летнего исследования, проведенного на >400 пациентов с подагрой без СД 2 типа, оказалось, что помимо "традиционных" ФР с развитием СД 2 типа ассоциируется ГУ, а также показатели, отражающие тяжелое течение подагры (наличие тофусов, частые приступы артритов), тогда как уровень МК <300 мкмоль/л, достижение которого было следствием лекарственной терапии, напротив отождествлялся с достоверным снижением риска СД 2 типа [96,97].…”