High prevalence of gout in patients with Type 2 diabetes: male sex, renal impairment, and diuretic use are major risk factors.
OBJECTIVE
Gout and hyperuricaemia are recognised features of the metabolic syndrome. The objective of this study was to determine the prevalence of gout in patients with diabetes.


METHODS
We studied 292 consecutive outpatients attending diabetes clinics between August and September 2005. A self-reported history of gout was obtained, and was confirmed by clinical chart review. Information regarding associated comorbidities was also recorded. Current treatments were compared with published EULAR guidelines for the management of gout.


RESULTS
Gout was confirmed in 0/27 (0%) patients with Type 1 diabetes and 59/265 (22%) of patients with Type 2 diabetes (p<0.01). Prevalence rates varied depending on age and sex, and were highest (41%) in men with type 2 diabetes over the age of 65 years. Multivariate analysis showed that the following variables were independent predictors for gout in patients with Type 2 diabetes: male sex (adjusted OR 4.4, 95%CI 2.1-9.6), impaired renal function (adjusted OR 1.2 for every 10 ml/min reduction in GFR, 95%CI 1.1-1.4), diuretic use (adjusted OR 3.2, 95%CI 1.6-6.6), and high triglycerides (adjusted OR 2.2, 95%CI 1.0-4.7) Only 28/59 (47%) of patients with gout were on urate-lowering therapy. A further 24/59 (41%) met recommended criteria for urate-lowering therapy but were not receiving this medication.


CONCLUSIONS
This study has demonstrated a high prevalence of gout in patients with Type 2 diabetes. Improved recognition of those at high risk of gout is needed to ensure optimal management of these patients.
Suppiah
Ravi
R
Department of Rheumatology, Middlemore Hospital, Counties Manukau District Health Board, Private Bag 93311, Otahuhu, Auckland, New Zealand. RSuppiah@middlemore.co.nz
Dissanayake
Ajith
A
Dalbeth
Nicola
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004232:Diuretics / Q000009:adverse effects; D005260:Female; D006073:Gout / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D015995:Prevalence; D051437:Renal Insufficiency / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors
D004232:Diuretics