Background/Purpose: Previous studies suggest that patients with gout are at increased risk for developing diabetes.¹ One possible explanation for this increased risk is the activation of pathologic pathways common to both diabetes and gout, including IL-1b.² Among its many mechanisms, colchicine has been found to suppress activation of the NLRP3 inflammasome, inhibiting activation of IL-1b. Colchicine may also activate AMPK, a downregulator of inflammation and gluconeogenesis.³ In the present study, we investigated whether chronic colchicine use reduces diabetes incidence among patients with gout.

Methods: We reviewed the Computerized Patient Record System (CPRS) of the New York Harbor Veterans’ Affairs Healthcare System to assess the incidence of diabetes between 2000 and 2015 among 140 randomly selected patients with gout who had taken colchicine daily for some or all of the study period. We compared the diabetes incidence among these patients with 115 randomly selected patients with gout who did not take colchicine during the same time period. At study entry, all subjects met a modified version of 1977 ARA gout classification criteria and had no diabetes diagnosis. Patients were excluded if their duration of colchicine use was <60 contiguous days. Incident diabetes was defined as a new hemoglobin A1c value of ≥6.5% during the study period.

Results: Among gout patients who had taken colchicine, we observed no difference in diabetes incidence compared to patients not taking colchicine (17.1% versus 17.4%, OR = 0.983, p = 1.0). When patients were analyzed by duration of colchicine use, there was no significant difference in diabetes incidence between patients in the longest (36.5 to 114 months) compared to the shortest tertile (2.3 to 14 months)(27.3% versus 9.1%, p=0.24) of colchicine exposure. Among patients in the colchicine group who experienced incident diabetes during the study period (n=24), 50% (n=12) were actively taking colchicine at the time of their diagnosis and 50% (n=12) had discontinued colchicine use prior to their diabetes diagnosis.

Conclusion: We found no significant difference in the 15-year diabetes incidence between patients taking colchicine and those not taking colchicine, suggesting that colchicine is not beneficial to prevent incident diabetes. Larger and prospective studies will be needed to confirm this observation.

References

1. Tung Y-C et al. Am J Med. 2016;129(11):1219.e17-e1219.e25.
2. Ehses JA et al. Proc Natl Acad Sci. 2009;106(33):13998-14003.
3. Wang Y et al. Ann Rheum Dis. 2016;75(1):286-294.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effect-of-colchicine-on-diabetes-incidence-among-gout-patients-in-a-veterans-affairs-population/