Type 2 Diabetes And Gout

Consuming Too Much Sugar

Gout

High fructose consumption has been linked to increased uric acid.

• HFCS is the sweetener of choice in soft drinks and many processed foods.
• High fructose consumption increases body weight, one of the highest risk factors for raised uric acid levels and gout.

Type 2 Diabetes

According to a 2010 study, the risk of developing diabetes is 26 % higher for those who drink one or more sugary drinks every day.

• Its believed that the regular consumption of sugar sweetened soft drinks increases glucose intolerance and insulin resistance.
• And regular sugary drinks consumption also leads to unwanted weight gain, a high risk factor for type 2 diabetes.

Note: Regular consumption of processed foods containing sugar and refined carbs increases the risk of both conditions in the same way as sugary drinks.

Blood Collection And Laboratory Measurements

After an overnight fast , blood samples were obtained from the participants by means of venipuncture. The samples were then put into an ice-cooled box and transported immediately to the clinical lab at the Department of Biochemistry and Molecular Biology. After centrifugation of blood samples at 3000 rpm for 15 min, the serum was isolated and stored at 20 °C. The serum glucose concentration was measured within 3 h after of blood collection. Serum uric acid , total cholesterol , triglycerides , high-density lipoprotein , serum albumin and total protein were measured by colorimetric methods with a semi-auto biochemistry analyzer . Commercially available diagnostic kits were used for the analysis of the above markers. All measurements were carried out in the clinical lab of the Department according to the standard manufacturers protocols. All laboratory tests were performed by trained graduate level students and precision of the measurements was maintained by regular method calibration with the reference standard.

Sglt2 Inhibitors Reduced Gout Incidence By 11% In Patients With Type 2 Diabetes

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Patients with type 2 diabetes who receive sodium-glucose transport protein 2 inhibitors may have a lower risk for gout compared with those using dipeptidyl peptidase 4 inhibitors, according to data published in JAMA Network Open.

Sodium-glucose transport protein 2 inhibitor administration reduces blood glucose levels and is currently the standard intervention for preventing diabetic kidney disease progression and cardiovascular disease in patients with T2DM,Mu-Chi Chung, MD, of Taichung Veterans General Hospital and National Chung Hsing University, in Taiwan, and colleagues wrote. In a previous trial, different SGLT2 inhibitor medications consistently lowered blood urate levels to 0.3-0.9 mg/dL.

In general, the kidney accounts for approximately 70% of urate elimination, and SGLT2 inhibitors could facilitate glucose transporter 9 excretion of more urine uric acid in exchange for glucose reuptake by increasing glucose concentrations in glomerular filtrate, they added. Because hyperuricemia is accepted as the most important risk factor for development of gout, we speculated whether SGLT2 inhibitor use influences the risk of gout. To date, no association between SGLT2 inhibitor use and the incidence of gout have been established.

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Sugar Sweetened Beverage Consumption Among Adults With Gout Or Type 2 Diabetes

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  Affiliations Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand, Maurice Wilkins Centre for Biodiscovery, Auckland, New Zealand

• Affiliation Population Health Directorate, Counties Manukau District Health Board, Auckland, New Zealand

• Affiliations Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand, Department of Renal Medicine, Waitemata District Health Board, Auckland, New Zealand

• Affiliation Department of Medicine, University of Otago, Christchurch, New Zealand

• Affiliation Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

• Affiliation Department of Biochemistry, University of Otago, Dunedin, New Zealand

Having High Blood Pressure

Gout

According to a 2014 study hypertension is a major risk factor for gout.

• Approximately 75% of gout patients have high blood pressure.
• And diuretics, taken to combat high blood pressure, can raise uric acid levels in the blood.
• So both the condition and the medicine used to alleviate it increases the risk of gout.

Type 2 Diabetes

A 2015 study concluded that people with high blood pressure have a higher risk of developing type 2 diabetes.

• Around 80% of people with type 2 diabetes have high blood pressure.
• But researchers dont know why theres such a compelling relationship between the two conditions.
• There is a view that inflammation in the body arising from hypertension may play a role.

Read Also: Can I Eat Eggs If I Have Gout

This Is Important News Since Type 2 Diabetes And Gout Have Many Risk Factors In Common To Begin With

People with type 2 diabetes are more likely than average to develop gout, though its not clear if its the diabetes itself or other common risk factors like obesity and hypertension that explain the connection. While lifestyle changes like cutting back on salt and reducing calories in order to lose weight may help a type 2 diabetes patient lower their chances of ending up with gout, it appears that the drugs used to treat diabetes might also tip the balance one way or the other.

According to a new study presented at the 2019 American College of Rheumatology/Association of Rheumatology Professionals Annual Meeting in Atlanta, people with diabetes who took a drug in the GLP1 agonists class were more apt to develop gout compared to those who used an SGLT2 inhibitor instead.

GLP1 agonists are injectible medications that mimic a hormone called glucagon-like peptide-1, which prompts the pancreas to make more insulin. GLP1 agonists include exenatide , liraglutide , and dulaglutide , among others.

SGLT2 inhibitors are oral medications that lower blood sugar by causing more of it to be excreted in urine. They include canagliflozin , dapagliflozin , and empagliflozin .

As expected, patients taking SGLT2 inhibitors were also less likely to develop heart failure.

Read more here about gout comorbidities, including the link between type 2 diabetes and gout.

Risk Factors For Gout And Diabetes

Many of the same things can make your chances of having gout or diabetes go up. You may be more likely to get them if you:

• Are overweight or obese. If you carry extra fat on your body, youâre more likely to have both gout and type 2 diabetes.
• Drink too much alcohol. Moderate amounts of alcohol — one drink a day for women and men over 65 and two for men 65 and younger — may actually lower your chances of getting diabetes. But too much can affect how your pancreas releases insulin, which can lead to type 2 diabetes. More than two drinks a day can also up your odds of gout.
• Have a family history of them. If one of your family members has had gout or diabetes, youâre more likely to get these diseases, too.
• Have other health problems. High cholesterol and high blood pressure are linked to both conditions.

Read Also: All Natural Cures For Gout

Evidence Of Gout And Diabetes

New studies indicate that you have a 20% increased chance of developing diabetes and 40% increases risk of developing kidney disease if you have high levels of uric acid in your blood. A study conducted by Dr. Eswar Krishnan who is an assistant professor of rheumatology at Stanford University researched over a span of 3 years about 2000 men who had gout from a Veterans Administration database and note that none of these men had been diagnosed with neither diabetes nor kidney disease at the beginning of this study.

What they found was that 9% of men with gout who had high levels of uric acid developed diabetes compared to 6% of men whose uric acid levels were in the normal range. For those veterans who had high uric acid levels had a 19% increased risk of developing diabetes.

Another study conducted by the famous gout researcher H.K. Choi and also included Dr. Eswar Krishnan evaluated men with a high cardiovascular risk profile who had gout and the future risk of developing type 2 diabetes. They concluded that those men with gout and a high cardiovascular profile had an increased risk of developing type 2 diabetes later in life and the importance of maintaining an aggressive healthy lifestyle of a proper diet and exercise.

Here is what you can do to lessen your risk of developing diabetes as a gout sufferer:

The Role Of Insulin Resistance

High uric acid doesnt only cause inflammation, though. It can also trigger insulin resistance.

Insulin, a hormone produced in the pancreas, helps control the amount of sugar in your blood. Insulin resistance is when your body doesnt respond well to insulin, causing too much sugar to circulate in your bloodstream.

Physical activity, a moderate weight, and a balanced diet can sometimes reverse insulin resistance. But without treatment, insulin resistance can lead to prediabetes and type 2 diabetes.

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The Connection Between Gout And Type 2 Diabetes

An estimated eight million people in the United States have gout, according to the Alliance for Gout Awareness. Gout typically affects one joint at a time, with about 1 in 2 attacks beginning in the big toe joint.

Gout is caused by hyperuricemia, which can happen when there is too much uric acid in the body. Uric acid can build up in the joints, fluids, and tissues, which can lead to gout, according to the Centers for Disease Control and Prevention .

Risk factors for gout include being male, having obesity, and chronic conditions such as heart failure, high blood pressure, insulin resistance, metabolic syndrome, poor kidney function, and diabetes, according to the CDC.

Sometimes the pain and symptoms of gout go away temporarily, called remission, but can return suddenly and last days or weeks. Other symptoms include swelling, redness, and heat. Although the condition cant be cured, it can be effectively treated and managed through pain medication, and diet and lifestyle changes.

According to the study authors, SGLT2 inhibitors are already known to reduce uric acid levels, but whether that leads to reducing gout risk is still unclear. To further illuminate the impact, investigators used information from a healthcare claims database that contained individual information on healthcare use, health condition diagnoses, tests and procedures, lab results, and prescriptions filled.

RELATED: Do You Know the Risk Factors for Gout?

What Is Type 2 Diabetes

Note: I use sugar and glucose interchangeably here.

Type 2 diabetes is the most common form of diabetes , a chronic condition that results from a bodys inability to produce enough or use enough insulin, a hormone that controls blood sugar levels so that the levels never get too high or too low , both of which are very serious, life-threatening conditions.

Your bodys cells need glucose as fuel to produce energy, which glucose comes from carbohydrates in the food you eat. As your food is digested, your blood sugar level rises and triggers the pancreas to release insulin proteins into the bloodstream which attach themselves to your bodys cells and directs them to adsorb the sugar. Cells cannot adsorb glucose directly from the blood. They need that insulin.

But if your body isnt using the insulin properly it means that cells cannot adsorb the sugar which then remains in the blood. And as more food is digested, sugar levels rise even further, and more insulin is released into the bloodstream to deal with it. Its a vicious cycle that can eventually end up overstressing the pancreas and impeding its ability to produce enough insulin.

Common type 2 diabetes symptoms are frequent urination, excessive thirst, tiredness, drowsiness, blurred vision, genital itching, thrush, and slow healing cuts and wounds.

Its interesting to note that some 25% of people with type 2 diabetes are unaware they have it. So if you suffer from any of these symptoms see your doctor right away.

Recommended Reading: How To Get Rid Of Gout Crystals In Foot

Research Design And Methods

The Rotterdam Study has been described in detail elsewhere . Written informed consent was obtained from all participants, and the Medical Ethics Committee of Erasmus Medical Center approved the study. At baseline, serum uric acid was measured and prevalent diabetes cases were excluded . Incident cases of diabetes were diagnosed during follow-up based on the guidelines of the American Diabetes Association and World Health Organizatioin using the information from general practitioners, pharmacies databases, and fasting blood samples that were taken during follow-up examinations . The association was assessed by Cox regression analysis. The population-attributable risk and 95% CIs were calculated with use of the Interactive Risk Assessment Program .

Main Outcomes And Measures

A gout diagnosis was based on the International Classification of Diseases, Ninth Revision, Clinical Modification and the International Statistical Classification of Diseases, Tenth Revision, Clinical Modification . Multiple Cox proportional hazards regression models were used to calculate hazard ratios and 95% CIs.

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Subgroup Analyses And Potential Interactions

The association between history of gout and type 2 diabetes did not vary significantly by treatment group, presence of obesity, family history of type 2 diabetes, history of hypertension or presence of the metabolic syndrome . Similarly, the association between serum uric acid levels and type 2 diabetes did not vary significantly by these factors .

Gout And Risk Of Incident Diabetes

In the parallel analysis of gout and risk of hypertension, 2,223 participants reported to have incident diabetes during a mean follow-up of 6.2 years. Compared to participants without gout, those with gout had a 36% increased risk of developing diabetes however, the association vanished after adjustment for BMI and hypertension . A dose-response association between duration of gout and risk of diabetes was observed in the model without adjustment for BMI and hypertension, but not evident after adjustment for those two variables. The association was not substantially different in the 2-year lag analysis .

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What To Eat For Gout And Diabetes

If you have gout and diabetes, you may wonder which foods you can eat safely and which ones you need to avoid. It has been confirmed that diet can play a key role in controlling both health conditions. In general, you need to focus on limiting your dietary purine intake and restrict foods high in simple sugar.

Gout and diabetes connection

Several decades ago, gout was thought as a disease in rich people. But over time, it seems that gout can affect anyone, the number of cases for people with gout is now drastically on the rise.

This joint disease is closely related to obesity. And today obesity is a common condition. It can be a risk factor of diabetes , too. This is one of reasons why both diseases can be found together in many cases.

In other words, gouty arthritis and diabetes are different health condition, but they share some same risk factors such as obesity and abusing alcohol.

As well we know, diabetes is a condition of when the body is very poor in controlling the blood sugar level. In diabetic people, their insulin hormone doesnt work efficiently or is not enough produced to the body needs.

And for gouty arthritis, it starts to occur when some uric acids in the blood go to the joint and stay in there. Over time, the deposits of uric acids can form urate crystals. These can be needle-like crystals that can cause inflammation, causing a gout attack.

So, how your diet should go?

Watch on the calories!

Healthy foods for gout and diabetes

Lower Risk For Gout With Sglt2 Inhibitors Vs Glp1 Agonists In Type 2 Diabetes

ATLANTA Among adults with type 2 diabetes mellitus, sodium-glucose cotransporter 2 inhibitors are associated with a lower rate of gout compared with glucagon-like peptide-1 receptor agonists, according to study results presented at the 2019 American College of Rheumatology/Association of Rheumatology Professionals Annual Meeting, held November 8 to 13, 2019, in Atlanta, Georgia.

Of 111,419 pairs of patients , those newly prescribed an SGLT2 inhibitor showed a lower rate of gout compared with those newly prescribed a GLP1 agonist during the median 177-day follow-up. Heart failure was also lower with SGLT2 inhibitors however, SGLT2 inhibitors and GLP1 agonists were associated with similar rates of cellulitis .

Overall, adults with type 2 diabetes who received an SGLT2 inhibitor had a lower rate of gout compared with those who received a GLP1 agonist.

SGLT2 inhibitors may reduce the risk of developing gout among adults with type 2 diabetes mellitus, though future studies are necessary to confirm this observation, the study researchers concluded.

Reference

Recommended Reading: Signs And Symptoms Of Gout In Big Toe

Assessment Of Diabetes And Gout

Specifically, at both follow-up interviews, the participants were asked separately if they had been told by doctors that they had diabetes or gout. If the response was yes, participants were also asked about the age of first diagnosis. For cases of gout, the interviewers also verified with the participants that the diagnosis was based on joint pain and swelling attributed to reported hyperuricemia by their physicians. For cases of diabetes, a previous validation study was conducted in SCHS, and reported a positive predictive value of 99% when comparing self-reported diabetes status to the hospital-based discharge summary database and a supplementary questionnaire about symptoms, diagnostic tests, and medication use. Furthermore, 5.6% of 2,625 randomly selected participants who reported to be free of diabetes had HbA1c 6.5% and thus could be classified as diabetes using the recent diagnostic guidelines. Therefore, 94.4% of participants who reported to be free of diabetes were below the HbA1c cutoff for diabetes. All interviews were tape-recorded and subjected to quality checks.