Background/Purpose: Gout and type 2 diabetes mellitus (T2DM) are common in the United States (US), but little is known about potential associations of T2DM and hyperuricemia/gout with clinical outcomes. This study examined variations in gout severity, management, and health care utilization among gout patients with and without T2DM.

Methods: Data were assessed from a survey of US physicians and patient chart audits. Participating physicians managed the care of ≥50 patients with gout annually; chart audits were of their last 5 consecutive adult patients with confirmed gout. Gout severity was measured by physician global assessment, flares, organ/joint damage, and tophi. Treatment characteristics, presence of clinician-confirmed T2DM, and sociodemographics were identified. Descriptive and multivariate (stepwise logistic regression) statistics analyzed the differences among gout patients with and without clinician-confirmed comorbid T2DM, and assessed urate-lowering therapy (ULT) use and gout control.

Results: Overall, 1159 charts of patients with gout were abstracted (246 with T2DM, 913 without T2DM; 80.50% male; 71.18% Caucasian); for patients with gout aged ≥61, a significantly higher proportion had T2DM than did not have T2DM (68.71% vs 31.29%, P<0.01). Patients with gout and T2DM had longer mean duration of gout (63 vs 41 months), were more likely to have tophi (37% vs 20%), joint damage (24% vs 13%), and clinician-rated severe gout (27% vs 13%) than those without T2DM (all P<0.01). Patients with gout and T2DM were also more likely to receive ULT (86% vs 71%; P<0.01), and among those receiving ULT, T2DM patients treated with allopurinol received a similar mean daily dose (321 mg vs 298 mg; P=0.17). Gout patients with T2DM were more likely to have additional comorbidities (cardiovascular disease, kidney disease, COPD, depression, diabetes, hyperlipidemia, hypertension, obesity, prostate problems [men]) and have chronic pain than those without T2DM (all P<0.05). Gout patients with T2DM reported more office visits (4.1 vs 3.5), were more likely to have an emergency department visit (17% vs 9%), and were more likely to be hospitalized (5% vs 2%) (all P<0.01). In both groups, ULT use was associated with better gout control, but the specific factors predictive of ULT use and disease control varied between those with and without T2DM.

Conclusion: Gout patients with T2DM were more likely to have a greater impact on health system spending, with additional comorbidities and more severe gout than those without T2DM. These data suggest that patients with gout and T2DM constitute a less healthy group in need of careful monitoring and more aggressive gout management.