Background Growing evidence supports that hyperuricemia is independently associated with a greater future risk of metabolic syndrome and diabetes mellitus (DM). A previous cohort study that included men with a high cardiovascular risk profile found gout associated with a higher risk of incident DM compared to those with no gout.
Objectives 1) To estimate the overall and sex-specific incidence rate (IR) of DM among patients with and without gout; 2) to assess the risk of incident DM among gout compared with non-gout patients; and 3) to test whether the risk of incident DM associated with gout differs by sex.
Methods Using data from a US commercial insurance plan (2003-2012), we selected a cohort of adults aged ≥40 years who had no prior diagnosis of DM or use of anti-diabetic drugs at baseline. Gout patients who had ≥2 diagnoses for gout were followed from the index date, defined as the first date of gout-related drug dispensing. For the comparison group, patients with ≥2 diagnoses for osteoarthritis (OA) and ≥1 dispensing for an OA-related drug were identified and matched to the gout group on age, sex and index date with a 3:1 ratio. Incident DM was defined based on a diagnosis of DM and a dispensing for anti-diabetic drugs. Cox proportional hazards regression tested the overall and sex-specific effect of gout on DM risk after adjusting for potential confounders.
Results The study cohort consisted of 54,075 gout and 162,225 OA patients, matched on age, sex and index date. The mean age was 56.2 years and 84.8% were men. At baseline patients with gout experienced a greater frequency of hypertension, heart failure, coronary heart disease, chronic kidney disease, obesity, and hyperlipidemia compared to the OA group. Over a mean follow-up of 1.9 years, the IR of DM was 1.91 per 100 person-years in gout and 1.12 per 100 person-years in OA patients. After adjusting for age, comorbidities, medications, and health care utilization, gout was associated with an increased risk of DM (hazard ratio [HR] 1.45, 95%CI 1.37-1.54) for both sexes. The impact of gout on the risk of incident DM was greater in women than men compared to OA patients (Table) with a significant interaction between sex and gout (p=0.0009).
Conclusions Gout was associated with an increased risk of developing DM compared with OA after adjusting for potential confounders, and the risk associated with gout was higher among women than men. This relationship may help identify patients for diabetes prevention strategies and may also highlight an important metabolic intersection between two common diseases.
Disclosure of Interest S. Kim Grant/research support: Research grant from Pfizer, J. Liu: None declared, D. Solomon: None declared