Association between Gout, Urate-Lowering Therapy, and Risk of Developing Type 2 Diabetes Mellitus: A Nationwide Population-Based Retrospective Cohort Study

Abstract

Gout is the most prevalent inflammatory arthritis in adults. Although the link between gout and type 2 diabetes mellitus (T2DM) has been documented, our understanding of the association between urate-lowering therapy (ULT) among gout patients and T2DM development remains poor. We included 69,326 patients with new-onset gout in 2000-2011. Each case was matched randomly with 1 patient without gout during the study period, and 69,326 patients were recognized as the comparison cohort. A Cox proportional hazard regression model was used to analyze differences in the risk of T2DM development between patients with and without gout after considering related comorbidities. After adjusting for potential confounders, the case group had a higher risk of T2DM than the control cohort (adjusted hazard ratio aHR=1.30, 95%confidence interval CI=1.24-1.38; P<0.001). Gout patients without appropriate ULT had significantly higher risk of T2DM development than the control cohort (aHR=1.39; 95%CI=1.30-1.48; P<0.001). Among gout patients, those receiving ULT excluding probenecid (aHR=0.80; 95%CI=0.64-1.00), all had significantly lower risk of T2DM than gout patients without ULT (all aHR<0.90; all P<0.001). In this study, we found that gout increased the risk of T2DM; however, patients with any ULT exhibited a lower risk of T2DM than gout patients without any ULT (all aHR<0.90, P<0.001; excluding probenecid).