Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Clin Rheumatol. 2023 Nov;42(11):3067-3073. doi: 10.1007/s10067-023-06684-8. Epub 2023 Jul 3.
The effect of insulin use on gout risk remains unknown. This study aimed to investigate the association between insulin use and gout risk among patients with type 2 diabetes mellitus (T2DM).
Based on the Shanghai Link Healthcare Database, patients with newly diagnosed T2DM, with or without insulin exposure, were identified from January 1, 2014 to December 31, 2020, and followed until December 31, 2021. Apart from the original cohort, we also established a 1:2 propensity score-matched cohort. A time-dependent Cox proportional hazards model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for gout incidence associated with insulin exposure.
A total of 414,258 patients with T2DM, including 142,505 insulin users and 271,753 insulin non-users, were enrolled in this study. After a median follow-up of 4.08 years (interquartile range, 2.46-5.90 years), the incidence of gout was significantly higher in insulin users than in insulin non-users (319.35 versus 302.20 cases per 100,000 person-years; HR 1.09, 95% CI 1.03-1.16). The results were robust in propensity score-matched cohort, sensitivity analyses, and stratified analysis of aspirin. In other stratified analyses, the association between insulin use and increased gout risk was found only in patients who were female, or aged 40-69 years, or without hypertension, dyslipidemia, ischemic heart disease, chronic lung disease, kidney disease, or not using diuretic.
Insulin use is associated with a significantly increased risk of gout among patients with T2DM. Key Points • The first real-world study to investigate the effect of insulin use on gout risk. • Insulin use is associated with a significantly increased risk of gout among patients with type 2 diabetes mellitus.
胰岛素使用对痛风风险的影响尚不清楚。本研究旨在探讨 2 型糖尿病（T2DM）患者中胰岛素使用与痛风风险之间的关系。
基于上海联康医疗数据库，从 2014 年 1 月 1 日至 2020 年 12 月 31 日期间，确定了新诊断为 T2DM 的患者（有无胰岛素暴露），随访至 2021 年 12 月 31 日。除了原始队列外，我们还建立了一个 1:2 的倾向评分匹配队列。采用时间依赖性 Cox 比例风险模型来估计与胰岛素暴露相关的痛风发病率的风险比（HR）和 95%置信区间（CI）。
共纳入 414258 例 T2DM 患者，其中 142505 例为胰岛素使用者，271753 例为胰岛素非使用者。中位随访时间为 4.08 年（四分位距，2.46-5.90 年），胰岛素使用者的痛风发病率明显高于胰岛素非使用者（319.35 与 302.20 例/100000 人年；HR 1.09，95%CI 1.03-1.16）。在倾向评分匹配队列、敏感性分析和阿司匹林分层分析中，结果均具有稳健性。在其他分层分析中，仅在女性、年龄 40-69 岁、无高血压、血脂异常、缺血性心脏病、慢性肺部疾病、肾脏疾病或未使用利尿剂的患者中，发现胰岛素使用与痛风风险增加之间存在关联。
胰岛素使用与 T2DM 患者的痛风风险显著增加相关。
关键点
• 首个真实世界研究调查胰岛素使用对痛风风险的影响。
• 胰岛素使用与 2 型糖尿病患者的痛风风险显著增加相关。
