Abstract
Aims Although several epidemiological studies have investigated the relationship between diabetes mellitus (DM) and the risk of gout, the results are inconsistent. Therefore, we systematically retrospected available observational studies to clarify the impact of DM on the risk of gout. Methods Embase, PubMed, Cochrane Library, Scopus, Web of Science, and China National Knowledge Infrastructure were searched for relevant articles from inception to 2 March 2020. The quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. The multivariate adjusted relative risks (aRR) and corresponding 95% confidence intervals (CI) were pooled based on a random-effect model. Cochran's Q test and I2 were used to evaluate heterogeneity. Results Five studies involving 863,755 participants were included in our meta-analysis. DM was associated with a lower risk of gout (aRR: 0.66; 95% CI: 0.59 to 0.73) but had a high heterogeneity (I2 = 89.2%). Metaregression analysis revealed that the types of DM were the source of heterogeneity. Subgroup analysis by types of DM showed that the risk of gout was significantly lower in type 1 DM (T1DM) (aRR: 0.42; 95% CI: 0.28 to 0.63) than in type 2 DM (T2DM) (aRR: 0.72; 95% CI: 0.70 to 0.74). Furthermore, when stratified according to gender in DM, sex-specific association was found. The inverse association was observed in males only (aRR: 0.57; 95% CI: 0.43 to 0.77) and not in females (aRR: 0.96; 95% CI: 0.87 to 1.05). Further stratified based on glycated hemoglobin (HbA1c) levels in DM, raised A1C levels were associated with a reduced risk of gout in patients with DM. Conclusions This meta-analysis indicated that DM was related to a lower risk of gout, and the protective effect of DM on the risk of gout was stronger in males, T1DM, or DM with high HbA1c levels. However, more prospective cohort studies are required to confirm these results.
Highlights
Gout is a crystal-associated arthropathy characterized by the deposition of monosodium urate (MSU), which is directly related to hyperuricemia caused by disorders of purine metabolism and/or decreased uric acid excretion
After checking the records and removing duplicates, 2423 articles were screened by titles and abstracts. 2392 articles were removed due to irrelevant studies, leaving 31 articles for full-text review. 26 of the 31 articles were rejected for the following reasons: the effect of gout/hyperuricemia on the risk of diabetes mellitus (DM) (n = 12), not event as outcome (n = 3), subject not relevant (n = 3), studies without control group (n = 5), study failure to prove the diagnosis of DM prior to gout (n = 1), republished study (n = 1), and incomplete data (n = 1)
Whereas the effect of insulin on the reabsorption of uric acid was stronger in women than in men, we propose that the opposed effects just cancel each other out in females
Summary
Gout is a crystal-associated arthropathy characterized by the deposition of monosodium urate (MSU), which is directly related to hyperuricemia caused by disorders of purine metabolism and/or decreased uric acid excretion. The prevalence of gout accounts for approximately 5% of the middleaged and elderly global population, and the incidence of gout has increased steadily in recent years [1, 2]. Individuals with T2DM generally have a higher prevalence of high blood pressure [3], obesity, and decreased kidney function [4]. These comorbid conditions are risk factors of gout. Both DM and gout are related to a high risk of cardiovascular events, kidney failure, and mortality [4,5,6,7]. The relationship between DM and gout has attracted great attention
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