Screen for diabetes and aggressively manage risk factors in patients with gout, especially women, investigators concluded from a retrospective, matched cohort study published Oct. 2 in Annals of the Rheumatic Diseases.
They found that women have a 71% greater risk of developing diabetes if they have gout (hazard ratio, 1.71; 95% confidence interval, 1.51-1.93; P less than .001), and men with gout have a 22% greater risk (HR, 1.22; 95% CI, 1.13-1.31; P less than .001), compared with the general population.
Dr. Hyon K. Choi
The study “suggests that gout may be independently associated with an increased risk of diabetes. These findings were independent of BMI [body mass index], lifestyle factors, and other known risk factors. The magnitude of excess diabetes risk in gout was significantly larger among women than men, both in risk difference and relative risk, and these findings persisted across all age categories. These findings support aggressive management of risk factors of diabetes in patients with gout,” concluded senior investigator Dr. Hyon K. Choi and his colleagues at Boston University (Ann. Rheum. Dis. 2014 Oct. 2 [doi: 10.1136/annrheumdis-2014-205827]).
Using 15 years’ worth of data from the U.K. Health Improvement Network, which contains the records of about 7.3 million patients, the investigators matched 35,339 patients with newly diagnosed gout with up to 5 control subjects for age, sex, and BMI; they then looked to see who subsequently developed diabetes.
Among patients with gout, there were 10.1 cases of new-onset diabetes in women and 9.5 cases in men per 1,000 person-years. Among the 137,056 controls without gout, there were 5.6 cases of new-onset diabetes in women and 7.2 cases in men per 1,000 person-years.
After adjustment for smoking, alcohol consumption, physician visits, comorbidities, medication use, and BMI as a continuous variable, gout increased the risk of diabetes by 48% in women (HR, 1.48; 95% CI, 1.29-1.68; P less than .001) and by 15% in men (HR, 1.15; 95% CI, 1.06-1.24; P less than .001). The sex difference persisted across age groups.
Gout patients consumed more alcohol, visited their doctor more often, had more health problems, and took steroids and diuretics more frequently than did those who did not have gout. Overall, 72.4% of the gout cases were in men with a mean age of 62.7 years; the rest were in women, but women with gout tended to be a bit older, with a mean age of 67.9 years.
Perhaps, “low-grade inflammation among patients with gout promote[s] the diabetogenic process,” the investigators wrote. “Alternatively, the link may stem from the shared metabolic factors of the two conditions, such as the correlates of the metabolic syndrome or shared genes. Furthermore, the link between hyperuricemia and the risk of type 2 diabetes may originate at the renal level, as insulin resistance and higher insulin levels are known to reduce renal excretion of urate,” they noted.
It’s unclear why women seem to be more affected. “SUA [serum uric acid] levels in men are about 1 mg/dL higher than in women during adulthood, although levels in women increase around natural menopause. Thus, the physiological impact of uric acid levels, which are high enough to cause gout, could be stronger among women than men. Furthermore, female gout patients may have higher SUA levels on average than male gout patients, which could also contribute to a larger association with the risk of diabetes among women,” they suggested.
Dr. Choi previously linked gout to the development of diabetes, but only in men with high cardiovascular risk profiles (Rheumatology 2008;47:1567-70).
The investigators had no disclosures. The work was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases.