1. Patients diagnosed with gout had a higher risk of developing diabetes than the general population.
2. Women with gout carried a higher risk of developing diabetes than men.
Evidence Rating Level: 3 (Average)
Study Rundown: Gout is a painful inflammatory arthritis that can have substantial impact upon the cardiovascular system. While increased cardiovascular complications are associated with gout, it is unclear if gout raises the risk of metabolic and endocrine diseases as well. This study from the United Kingdom found that patients with gout had a higher risk of developing diabetes than their age and BMI-matched counterparts. Further, women with gout consistently showed higher diabetes risks than men. Multivariate analysis showed that the increased risk of diabetes was independent of lifestyle habits, including smoking, alcohol use, drug use, and increased primary care visits. Restricting the inclusion criteria to only patients that were given anti-gout medications did not change the results.
Though other studies have shown an increased risk of diabetes in men with gout and cardiovascular risk factors, this is the first study to show a link between gout and increased diabetes in a large, heterogeneous cohort of men and women. While this study was not able to comment on the effect of dietary factors, such as sugar drink intake, a clear link between gout and increased diabetes risk was thoroughly established. A follow up prospective cohort study would help validate the findings of this case-control study.
In-Depth [case-control study]: 9693 female and 25,646 male patients with gout and 37,881 female and 99,175 male patients without gout were compared using The Health Improvement Network (THIN) database from January 1995 to May 2010. One patient with gout was sex-matched to five non-gout patients by BMI, age, and entry into the study. Study demographics showed that women with gout were older than men, and that gout patients had a higher rate of alcohol use, primary care visits, co-morbidities, and glucocorticoid and diuretic use. The absolute risk difference for diabetes in patients with gout was 4.5 per 1000 cases in women and 2.3 per 1000 cases in men (p = 0.001). Hazard ratios (HR) for women and men were 1.71 (CI95% = 1.51-1.93) and 1.22 (CI95% = 1.13-1.31), respectively. These HR remained significant after multivariate analysis for lifestyle habits and was significant regardless of age. A sensitivity analysis restricted gout patients to those being treated with at least one anti-gout drug, but the sex-specific increases in diabetes risk remained the same.
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