Gout: An Overlooked Disease in Patients With Diabetes?

What is it about?

This study assessed gout treatment in patients with diabetes of whom many (20%?) have gout and often overlooked. Gout treatment was inadequate potentially leading to ulcerating tophi. Brief initial nurse-led care improves outcomes. Patients with suboptimally treated gout not only suffer because of painful flares, low quality of life, and tophi that may ulcerate, but studies indicate that flares are followed by a doubling of the risk of myocardial infarction or stroke in the following months. Achieving an average p-urate concentration <0.36 mmol/L (<6 mg/dL) is associated with an absence of gout flares and a reduction in the number of flares in the subsequent 12 months in people with gout. P-urate levels should also be lowered enough (<0.30 mmol/L [,5 mg/dL]) to promote dissolution of urate deposits in patients with tophaceous gout such as in the feet.

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Why is it important?

• Most patients with gout receive suboptimal urate-lowering treatment to prevent or dissolve urate deposits (tophi). • In this study, among patients with diabetes and gout, 67% maintained urate levels to prevent tophi. However, 50% of patients with diabetes presented with tophi, and after 2 years, only 45% achieved the lower urate level necessary to dissolve tophi. • Gout in patients with diabetes is often inadequately managed, leading to the persistence of tophi, which may mimic foot ulcers.

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