Gout Linked to Increased Risk for Diabetes, Renal Disease

Two studies show that uncontrolled serum uric acid levels are associated with a nearly 20% increased risk of developing diabetes and a more than 40% increased risk of developing renal disease….

Bhavik J. Pandya, MD, from Takeda Pharmaceuticals International, and colleagues studied 1923 patients in the Veterans Integrated Services Network 16 database. All were adult males with gout, and all had 2 serum uric acid measurements taken between January 1, 2002 and January 1, 2011. The study population was 52% white, average age was 62.9 years, average body mass index (BMI) was 30.6 kg/m², and average follow-up time was 80 months. Major comorbidities at baseline included hypertension (93%), hyperlipidemia (64%), cardiovascular diseases (30%), and smoking (8%).

Diabetes was identified, according to use of antidiabetic medications, or if the patient had a glycated hemoglobin of 6.5% or higher. Excluded from the study were patients with a history of inflammatory diseases — such as rheumatoid arthritis, lupus, scleroderma, vasculitis, or pseudogout — and those with diabetes diagnosed prior to the index date. Follow-up was broken down into 6-month periods.

Patients with controlled serum uric acid levels had significantly higher diabetes-free rates at year 1, 2, and 3 than patients with uncontrolled serum uric acid levels (96% vs 94%; 91% vs 88%; and 87% vs 81%, respectively; P = .001), the authors report in their abstract.

In addition, uncontrolled serum uric acid levels were associated with a significantly higher risk of developing diabetes (hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.01 to 1.41).

A second study, conducted by the same researchers using the same database, showed that in 2116 patients (53% white; average age, 62.6 years; mean BMI, 31.2 kg/m², indicating a generally obese group; and average follow-up, 80 months), the risk of developing renal disease was significantly higher in those with uncontrolled serum uric acid levels than in those with controlled levels.

Patients with controlled serum uric acid levels had significantly higher renal disease-free rates at year 1, 2, and 3 compared with patients with uncontrolled serum uric acid (96% vs 92%; 93% vs 87%; and 90% vs 82%, respectively; P = .0001).

Cox proportional hazards model confirmed that uncontrolled serum uric acid levels were associated with a significantly higher risk for renal disease (HR, 1.43; 95% CI, 1.20 to 1.70).

“Compared with controlled serum uric acid levels, uncontrolled serum uric acid levels are associated with an increased risk of a new diagnosis of renal disease among veterans with gout,” Dr. Pandya and colleagues report in their abstract.

American College of Rheumatology (ACR) 2011 Annual Meeting: Abstracts 1602 and 1032. November 7, 2011

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