Is there a relationship between diabetes and gout?

Relationship Between Diabetes and Gout

Yes, diabetes plays a significant role in gout, but the relationship is complex - while diabetes-related conditions increase gout risk, diabetes itself may actually reduce the risk of developing gout through uricosuric effects of glycosuria. 1

Diabetes as a Risk Factor for Gout

• Type 2 diabetes is recognized as one of the comorbidities that has contributed to the rising prevalence of gout in many countries, including the USA, over the last few decades 2
• Diabetes is part of the metabolic syndrome cluster (along with hypertension, obesity, and hyperlipidemia) that is commonly associated with hyperuricemia and gout 2
• The prevalence of diabetes among patients with hyperuricemia and gout is high - approximately 19.1% in patients with hyperuricemia and 16.7% in patients with gout 3
• Regional variations exist, with North American patients showing higher prevalence of diabetes (20.7%) among those with gout compared to other continents 3

Paradoxical Protective Effect of Diabetes

• Despite the association between diabetes and gout risk factors, diabetes itself may actually reduce the future risk of developing gout (adjusted RR 0.67,95% CI 0.63-0.71) 1
• This protective effect appears to be stronger:
  • With longer duration of diabetes (RR 0.52 for ≥10 years of diabetes) 1
  • In Type 1 diabetes (RR 0.33) compared to Type 2 diabetes (RR 0.69) 1
  • Among men compared to women 1
• The mechanism may involve the uricosuric effect of glycosuria or impaired inflammatory response in diabetic patients 1, 4

Sex Differences in the Diabetes-Gout Relationship

• The prevalence of gout is highest (41%) in men with type 2 diabetes over the age of 65 years 5
• Male sex is an independent predictor for gout in patients with Type 2 diabetes (adjusted OR 4.4,95% CI 2.1-9.6) 5
• The protective effect of diabetes against gout is stronger in men than women 1, 6

Other Risk Factors in Diabetic Patients

• Several factors increase gout risk in diabetic patients:
  • Impaired renal function (adjusted OR 1.2 for every 10 ml/min reduction in GFR) 5
  • Diuretic use (adjusted OR 3.2) 5, 3
  • High triglycerides (adjusted OR 2.2) 5

Clinical Implications

• When evaluating a patient with both diabetes and gout, clinicians should consider that the gout may be more related to comorbid conditions than to diabetes itself 6
• Patients with diabetes and uric acid stones have a lower risk for gout than non-diabetic patients with uric acid stones (adjusted OR 0.08) 4
• HbA1c levels may be inversely associated with gout risk in men with diabetes 6
• Controlling both plasma glucose and uric acid levels is critical for optimal management of patients with both conditions 3

Management Considerations

• Associated comorbidities and risk factors such as hyperlipidemia, hypertension, hyperglycemia, and obesity should be addressed as an important part of gout management 2
• Some treatments for comorbidities may benefit both conditions (e.g., losartan for hypertension and fenofibrate for hyperlipidemia can also reduce serum urate levels) 2
• Recognition and treatment of comorbidities should be considered part of holistic gout management 2

The complex relationship between diabetes and gout highlights the importance of comprehensive assessment and management of both conditions, recognizing that while diabetes-related metabolic factors increase gout risk, diabetes itself may have a paradoxical protective effect against developing gout.