Impact of diabetes against the future risk of developing gout

Abstract

OBJECTIVE Although type-2 diabetes is considered a comorbid condition of gout, the uricosuric effect of glycosuria or the impaired inflammatory response in diabetes may actually reduce the future risk of gout. We evaluated the impact of diabetes on the future risk of developing gout. METHODS We conducted a case-control study nested in a UK general practice database (the Health Improvement Network) by identifying all incident cases of gout (N=24,768) and randomly sampled 50,000 controls who were 20–79 years between 2000 and 2007. We examined the independent effect of type-1 and type-2 diabetes on the development of incident gout. RESULTS After adjusting for age, sex, body mass index, general practitioner visits, smoking, alcohol intake, ischemic heart disease, and presence of cardiovascular risk factors, the relative risk (RR) for incident gout among diabetes patients, as compared with individuals with no diabetes was 0.67 (95% CI, 0.63 to 0.71). The multivariate RRs with the duration of diabetes of 0–3, 4–9, and ≥ 10 years were 0.81 (95% CI, 0.74 to 0.90), 0.67 (95% CI, 0.61 to 0.73), and 0.52 (95% CI, 0.46 to 0.58), respectively. The inverse association was stronger with type 1 diabetes than with type 2 diabetes (multivariate RR, 0.33 vs. 0.69; P value < 0.001). The inverse association was stronger among men than women (multivariate RR [95% CI], 0.59 [0.53 to 0.64] vs. 0.90 [0.80 to 1.00]; P value for interaction <0.001). CONCLUSIONS Individuals with diabetes are at a lower future risk of gout independent of other risk factors. These data provide support for a substantial role of the pathophysiology associated with diabetes (e.g. the uricosuric effect of glycosuria and the impaired inflammatory response) against the risk of developing gout.

Impact of obesity and hypertriglyceridemia on gout development with or without hyperuricemia: A prospective study

“…They may deny drinking alcohol or may have abstained, but will drink alcohol at some social event in subsequent years (28). Patients with hyperglycemia were shown to have a lower future risk of gout, which also agreed with a previous report hypothesizing that lower sUA levels and the risk of gout at the diabetic stage were due to the development of uricosuria from glycosuria (29). Other potential limitations of this study may include misclassification of outcome from the criteria for the gout definition and recall bias from an individual's history.…”

Gout in Pregnancy: A Case Report and Review of the Literature

“…This curve is hypothesized to be related to the renal threshold of glucose reabsorption of 180 mg/dl. Higher levels of glucose will cause glycosuria followed by uricosuria; this explains why patients with diabetes have a reduced future risk of gout [20,21]. Meanwhile, higher insulin levels reduce the renal excretion of urate, and therefore the uric acid level increases linearly with insulin resistance [20].…”

Gout and Hyperuricemia—Serious Risk Factors for Morbidity and Mortality or Just Indicators of “The Good Life”—The Evidence to Date

“…One study compared 24,768 patients in the UK with incident gout to 50,000 randomly sampled controls and found that incident gout was much less prevalent in the patients with pre-existing diabetes, with the difference becoming more pronounced with increased duration of diabetes [43]. A study using data from NHANES examined the relationship between uric acid, hemoglobin A1C, fasting blood glucose, insulin, and C-peptide levels.…”