Spanish Centre for Pharmacoepidemiological Research (CEIFE), Madrid, Spain.
Ann Rheum Dis. 2010 Dec;69(12):2090-4. doi: 10.1136/ard.2010.130013. Epub 2010 Jun 22.
Although hyperuricaemia and gout are associated with an increased future risk of diabetes, diabetes may reduce the future risk of gout through the uricosuric effect of glycosuria or the impaired inflammatory response. The present work evaluates the impact of diabetes on the future risk of developing gout.
A case-control study nested in a UK general practice database (the health improvement network) was conducted by identifying all incident cases of gout (N=24 768) and randomly sampling 50,000 controls who were 20-89 years between 2000 and 2007. The independent effect of type 1 and type 2 diabetes on the development of incident gout was examined.
After adjusting for age, sex, body mass index, general practitioner visits, smoking, alcohol intake, ischaemic heart disease and presence of cardiovascular risk factors, the RR for incident gout among patients with diabetes, as compared with individuals with no diabetes was 0.67 (95% CI 0.63 to 0.71). The multivariate RRs with the duration of diabetes of 0-3, 4-9 and ≥ 10 years were 0.81 (95% CI 0.74 to 0.90), 0.67 (95% CI 0.61 to 0.73) and 0.52 (95% CI 0.46 to 0.58), respectively. The inverse association was stronger with type 1 diabetes than with type 2 diabetes (multivariate RR, 0.33 vs 0.69) and stronger among men than women (p value for interaction < 0.001).
Individuals with diabetes are at a lower future risk of gout independent of other risk factors. These data provide support for a substantial role of the pathophysiology associated with diabetes against the risk of developing gout.
尽管高尿酸血症和痛风与未来发生糖尿病的风险增加相关，但糖尿病可能通过尿糖的促尿酸排泄作用或降低炎症反应来降低未来发生痛风的风险。本研究旨在评估糖尿病对未来发生痛风风险的影响。
通过在英国一般实践数据库（健康改善网络）中进行病例对照研究，确定所有痛风（N=24768）的新发病例，并在 2000 年至 2007 年间随机抽取 50000 名年龄在 20-89 岁之间的对照者。检查 1 型和 2 型糖尿病对新发病例痛风的独立影响。
调整年龄、性别、体重指数、全科医生就诊次数、吸烟、饮酒、缺血性心脏病和心血管危险因素存在情况后，与无糖尿病者相比，糖尿病患者新发痛风的 RR 为 0.67（95%CI 0.63 至 0.71）。糖尿病病程为 0-3、4-9 和≥10 年的多变量 RR 分别为 0.81（95%CI 0.74 至 0.90）、0.67（95%CI 0.61 至 0.73）和 0.52（95%CI 0.46 至 0.58）。1 型糖尿病与 2 型糖尿病相比，这种相关性更强（多变量 RR，0.33 与 0.69），男性比女性更强（交互检验 p 值<0.001）。
糖尿病患者发生痛风的未来风险较低，独立于其他危险因素。这些数据支持与糖尿病相关的病理生理学在降低发生痛风风险方面发挥了重要作用。
