Urate-lowering therapy (ULT) may reduce the risk for type 2 diabetes (T2D) in patients with gout, according to study results published in Biomedical Research International.
While gout is a known risk factor for T2D, the relationship between ULT and T2D risk remains unclear.
Researchers conducted a retrospective cohort study of patients with gout using data from Taiwan’s Longitudinal Health Insurance Database. Patients who were diagnosed with new-onset gout between 2000 and 2012 were enrolled in the study; control participants who were matched with patients by index date, age, and sex were also included. The primary outcome was T2D, identified using the appropriate diagnostic codes. The cumulative incidence rates of T2D were calculated for both groups using the Kaplan-Meier method. Incidence of T2D was also compared between the ULT and non-ULT patient groups. Cox proportional hazards models were used to compute risk for T2D among study participants with and without gout. Models were adjusted for age, sex, and comorbid conditions.
The study cohort included 69,326 patients diagnosed with gout and 69,326 matched control participants. Mean age was 50.4±16.4 years among patients and 49.8±16.6 years among control participants, with the majority of participants in both groups being men (70.5% and 70.3%, respectively). A total of 69.3% of patients with gout were receiving ULT. Among patients with gout, the incidence of T2D was 7.14 per 1000 person-years and among control participants, the incidence was 4.42 per 1000 person-years.
In models adjusted for age, sex, and comorbid conditions, study participants with vs without gout remained at significantly elevated risk for T2D (hazard ratio [HR], 1.30; 95% CI, 1.24-1.38; P <.001). Compared with control participants, patients with gout not receiving ULT had an even higher risk for T2D (HR, 1.39; 95% CI, 1.30-1.48; P =.001). Compared with patients not receiving antigout treatment, patients receiving the following ULT medications had substantially lower risk for T2D: febuxostat (HR, 0.04; 95% CI, 0.01-0.17), sulfinpyrazone (HR, 0.57; 95% CI, 0.51-0.64), allopurinol (HR, 0.57; 95% CI, 0.54-0.61), benzbromarone (HR, 0.89; 95% CI, 0.86-0.93), and colchicine (HR, 0.72; 95% CI, 0.68-0.76;all P <.001). Only among patients receiving probenecid was the risk for T2D not substantially different from those not receiving ULT.
Results suggest that ULT may mitigate the risk for T2D in patients with gout. However, unmeasured confounders may have introduced bias to study findings; data on uric acid levels and lifestyle, including smoking status, alcohol consumption, and family history, were unavailable. Further research is necessary to assess the link between ULT and T2D.
“Our results provide insights that could facilitate the development of recommendations and guidelines for the clinical management of [patients with] gout and the effective mitigation of any long-term consequences such as [T2D],” the investigators concluded.
Fang Y-J, Chung Y-L, Lin C-L, Lim Y-P. Association between gout, urate-lowering therapy, and risk of developing type 2 diabetes mellitus: a nationwide population-based retrospective cohort study. Published online July 28, 2020. Biomed Res Int. doi:10.1155/2020/6358954