Does diabetes mellitus (DM) increase the risk for gout or pseudogout, also known as calcium pyrophosphate deposition disease (CPPD)?

From the Guidelines

Yes, diabetes increases your risk for gout, though the relationship with pseudogout is less clear. Diabetes contributes to gout development through several mechanisms: insulin resistance impairs uric acid excretion by the kidneys, leading to higher blood uric acid levels; obesity, which often accompanies type 2 diabetes, independently increases gout risk; and diabetic kidney disease can further reduce uric acid clearance 1. Additionally, some medications used to treat diabetes and its complications, such as diuretics for hypertension, can raise uric acid levels.

Key Points to Consider

• The European League Against Rheumatism recommends systematic assessment for the presence of associated comorbidities in people with gout, including diabetes 1.
• Risk factors for chronic hyperuricaemia, such as chronic kidney disease and overweight, should be searched for in every person with gout 1.
• Managing blood sugar is an important part of reducing gout attacks in diabetic patients, alongside traditional gout treatments like allopurinol, febuxostat, or colchicine during acute flares.
• While pseudogout (calcium pyrophosphate deposition disease) shares some symptoms with gout, current research hasn't established as strong a direct link between diabetes and pseudogout, though the metabolic abnormalities in diabetes might potentially influence calcium crystal formation.
• Diabetic patients should monitor for joint pain, swelling, and redness, as these could indicate either condition requiring medical attention.

Management and Prevention

• Identification of person-specific risk factors for hyperuricaemia is crucial, as some of these are modifiable 1.
• Lifestyle modifications, such as gradual weight loss in obese patients, can lower SUA levels and reduce the likelihood of gout flare.
• Implementations of lifestyle modifications are recommended for cardiovascular disease prevention, while prevention of kidney disease and excess alcohol consumption also need to be addressed.

From the Research

Relationship Between Diabetes and Gout

• The relationship between diabetes and gout is complex, with some studies suggesting that diabetes may reduce the risk of developing gout 2.
• A case-control study found that individuals with diabetes had a lower risk of developing gout, with a relative risk of 0.67 compared to those without diabetes 2.
• Another study found that genetically determined fasting insulin concentrations were positively associated with serum urate levels, suggesting that hyperinsulinemia may lead to hyperuricemia and increase the risk of gout 3.

Effect of Diabetes on Gout Risk

• A study found that the risk of gout was lower in individuals with diabetes, with a multivariate relative risk of 0.67 compared to those without diabetes 2.
• The same study found that the inverse association between diabetes and gout was stronger in men than in women, and stronger in individuals with type 1 diabetes than in those with type 2 diabetes 2.
• Another study found that gout was associated with an increased risk of developing diabetes, particularly in women 4.

Mechanisms Underlying the Relationship

• Hyperuricemia is a symptom of hyperinsulinism and metabolic syndrome, and the level of uricemia correlates with the degree of insulin resistance 5.
• A study found that high uric acid levels promoted urinary metformin excretion and decreased plasma metformin concentration, which may affect the disposition of metformin in patients with diabetes and gout 6.
• The relationship between diabetes and gout may be bidirectional, with hyperinsulinemia leading to hyperuricemia and increasing the risk of gout, while gout may also increase the risk of developing diabetes 3, 4.