title: Poorly controlled type 2 diabetes mellitus is associated with a decreased risk of incident gout: a population-based case-control study.
abstract: OBJECTIVE
  The aim of this study was to explore the risk of incident gout in patients with type 2 diabetes mellitus (T2DM) in association with diabetes duration, diabetes severity and antidiabetic drug treatment.
  
  
  METHODS
  We conducted a case-control study in patients with T2DM using the UK-based Clinical Practice Research Datalink (CPRD). We identified case patients aged ≥18 years with an incident diagnosis of gout between 1990 and 2012. We matched to each case patient one gout-free control patient. We used conditional logistic regression analysis to calculate adjusted ORs (adj. ORs) with 95% CIs and adjusted our analyses for important potential confounders.
  
  
  RESULTS
  The study encompassed 7536 T2DM cases with a first-time diagnosis of gout. Compared to a diabetes duration <1 year, prolonged diabetes duration (1-3, 3-6, 7-9 and ≥10 years) was associated with decreased adj. ORs of 0.91 (95% CI 0.79 to 1.04), 0.76 (95% CI 0.67 to 0.86), 0.70 (95% CI 0.61 to 0.86), and 0.58 (95% CI 0.51 to 0.66), respectively. Compared to a reference A1C level of <7%, the risk estimates of increasing A1C levels (7.0-7.9, 8.0-8.9 and ≥9%) steadily decreased with adj. ORs of 0.79 (95% CI 0.72 to 0.86), 0.63 (95% CI 0.55 to 0.72), and 0.46 (95% CI 0.40 to 0.53), respectively. Neither use of insulin, metformin, nor sulfonylureas was associated with an altered risk of incident gout.
  
  
  CONCLUSIONS
  Increased A1C levels, but not use of antidiabetic drugs, was associated with a decreased risk of incident gout among patients with T2DM.
authors.affiliation: Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland Hospital Pharmacy, University Hospital Basel, Basel, Switzerland.
authors.forename: Saskia G
authors.initials: SG
authors.lastname: Bruderer
authors.affiliation: Division of General Internal Medicine, Bern University Hospital, Inselspital, Bern, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Bodmer
authors.affiliation: Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Lexington, Massachusetts, USA.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Jick
authors.affiliation: Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland Hospital Pharmacy, University Hospital Basel, Basel, Switzerland Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Lexington, Massachusetts, USA.
authors.forename: Christoph R
authors.initials: CR
authors.lastname: Meier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology* / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006073:Gout / Q000453:epidemiology*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin; D013453:Sulfonylurea Compounds; C517652:hemoglobin A1c protein, human
keywords: Arthritis; Epidemiology; Gout