Published: Oct 2, 2014
By Nancy Walsh, Senior Staff Writer,
Action Points
Note that this U.K. population-based study documented an independent association between gout and subsequent development of diabetes.
Be aware that several important potential confounders, such as family history and diet, were not able to be included in the analysis.
The presence of gout was independently associated with later development of type 2 diabetes, a link that was particularly strong for women, a population-based study found.
The incidence rate for type 2 diabetes among individuals with gout was 9.6 (95% CI 9.4-9.8) per 1,000 person-years, compared with 6.7 (95% CI 6.6-6.8) per 1,000 among the general population, according to Hyon K. Choi, MD, and colleagues from Boston University.
On multivariate analysis that adjusted for factors such as body mass index (BMI), the hazard ratio for diabetes among women was 1.48 (95% CI 1.29-1.68) compared with 1.15 (95% CI 1.06-1.24) among men, the researchers reported online in Annals of the Rheumatic Diseases.
“Although gout’s cardinal feature is excruciatingly painful inflammatory arthritis, it is a metabolic condition associated with an elevated uric acid burden. Thus, gout is associated with obesity, hypertension, the metabolic syndrome, and an increased future risk of major cardiovascular events and premature mortality,” they wrote.
An earlier study identified an increased risk for type 2 diabetes among men with gout and other cardiovascular risk factors, but the risk in the general population has not been determined.
To explore this, Choi’s group analyzed data from The Health Improvement Network in the U.K., which includes more than 7 million patients.
They identified 9,693 women and 25,646 men with gout enrolled in the network between 1995 and 2010. A total of 137,056 controls were matched for age, time of enrollment, and BMI.
Covariates included smoking, alcohol consumption, comorbidities, medications, and healthcare usage.
At baseline, women with gout were older than men (67.9 versus 60.7 years). Patients with gout had more comorbidities, drank more alcohol, had more physician visits, and more often were treated with steroids and diuretics.
During 793,967 person-years, there were 5,856 new cases of diabetes diagnosed, with mean follow-up of 4.6 years.
The incidence rates for type 2 diabetes among women and men with gout were 10.1 and 9.5 per 1,000 person years, respectively, compared with rates of 5.6 and 7.2 per 1,000 among healthy female and male controls.
The greater risk among women compared with men persisted in all age subcategories after adjustment for age, sex, BMI, physician visits, smoking, alcohol, comorbidities, and medication use:
- Younger than 55, HR 1.77 (95% CI 1.27-2.48) versus HR 1.14 (95% CI 1-1.31)
- 55 to 69, HR 1.37 (95% CI 1.12-1.67) versus HR 1.17 (95% CI 1.04-1.31)
- 70 and older, HR 1.52 (95% CI 1.24-1.87) versus HR 1.11 (95% CI 0.93-1.31)
“The current study provides the first general population evidence for an independent association between gout and the risk for type 2 diabetes, and it fills the knowledge gap about the relation among women,” Choi and colleagues wrote.
“The clinical implication is that you have to be more vigilant in terms of recognizing and managing risk factors for diabetes among patients, especially women, with gout,” Choi told MedPage Today.
“This is relevant because gout is seen at least partially as a lifestyle-driven disease, so we try to recommend healthy lifestyle measures that would help prevent uric acid elevation,” he said.
There are several possible explanations for the link between gout and diabetes, he noted. “One is that the two conditions share pathogenic factors, primarily associated with the metabolic syndrome. A second is that uric acid levels or other gout features such as inflammation may somehow contribute,” he said.
“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,” he and his colleagues wrote.
As to why the association was stronger for women, they suggested that there may be differences in the metabolism of uric acid between women and men, and the physiologic effects of high uric acid may be greater for women.
Strengths of the study included its large population and its confirming the link seen previously in high-risk men, while a limitation was the lack of adjustment for diet, family history, and exercise.
The authors disclosed no financial relationships.
Primary source: Annals of the Rheumatic Diseases
Source reference: Rho Y, et al “Independent impact of gout on the risk of diabetes mellitus among women and men: a population-based, BMI-matched cohort study” Ann Rheum Dis 2014; DOI: 10.1136/annrheumdis-2014-205827.