ACR Meeting Abstracts

ACR Meeting Abstracts

  • Home
  • Meetings Archive
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018 ACR/ARHP Annual Meeting
    • 2017 ACR/ARHP Annual Meeting
    • 2017 ACR/ARHP PRSYM
    • 2016-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • Meeting Resource Center

Abstract Number: 178

The Effect of Initiating Pharmacologic Insulin on Serum Uric Acid Levels in Patients with Diabetes

Lindsey MacFarlane1, Chih-Chin Liu2 and Daniel H. Solomon3, 1Medicine, Brigham and Women's Hospital, Boston, MA, 2Rheumatology & Immunology, Brigham & Women's Hospital, Boston, MA, 3Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Diabetes, Gout and uric acid

  • Tweet
  • Email
  • Print
Session Information

Session Title: Metabolic and Crystal Arthropathies: Clinical Aspects

Session Type: Abstract Submissions (ACR)

Background/Purpose

Substantial evidence links gout and hyperuricemia to diabetes. Previous studies report an association between increasing uric acid (UA) levels, insulin resistance, and type 2 diabetes (T2DM).  Elevation in serum insulin is purported to increased serum UA levels through increased renal urate absorption.  This study sought to evaluate the effect of initiating insulin for T2DM on serum UA levels.

Methods

We conducted a retrospective analysis on patients with both T2DM and gout.  Patients were selected from a linked dataset from an electronic medical record (EMR) and Medicare claims data. This data set includes patients at one academic medical center with diagnoses of gout and hyperuricemia as confirmed in the EMR who also had T2DM (defined as hemoglobin A1c (HbA1c) > 6.5%, ICD-9-CM code 250.x or use of diabetic medications). An insulin-initiating cohort and a non insulin-initiating cohort were compared for changes in UA. Cohorts were matched on sex, age at first UA measurement, and length of time between UA measurements.  The first UA measurement occurred before insulin initiation and the second at least 3 months later; matched time points were used in the non-initiators.

Potential cofounders including HbA1c, creatinine, body mass index, length of time between UA measurements and medications (allopurinol, hydrochlorothiazide, losartan, tacrolimus, cyclosporine) were adjusted for in a series of linear regression models. 

Results

23 patients met criteria for insulin initiation and 23 were matched non-insulin initiators. Mean age was 59 and 57 years for the insulin and non-insulin cohorts, respectively, both cohorts were 52% female. Patients initiating insulin had a larger increase in mean UA levels, 6.41mg/dl to 7.66mg/dl  (mean change 1.25 mg/dl, interquartile range, IQR: -0.7,2.3) compared to non-insulin initiators, mean increase from 6.17mg/dl to 6.23mg/dl (mean change 0.06 mg/dl, IQR: -1.1,0.9 p = 0.06). Of the covariates, only length of time between UA measurements had an unadjusted p-value < 0.05 and was advanced to the final adjusted model.  The final linear regression showed that insulin use was associated with a 1.25mg/dl greater increase in UA levels when compared to non-insulin initiators  (p value = 0.02).  Adjusting for allopurinol did not attenuate results.  (Table)

Conclusion

Insulin initiation in patients with T2DM was associated with a statistically significant increase in serum UA levels. This may have clinical implications, including risk of gout flares.  Gout attack prophylaxis might be useful in the setting of insulin initiation among patients with gout. A prospectively designed study would help overcome potential limitations of our retrospective design.

Table 1. Regression analysis of covariate effects on change in uric acid in insulin initiators

Model

β

95% CI

P

A

Crude Model: Insulin + UA1

1.29

0.15, 2.44

0.03

B

Model A + age + months between UA1 & UA2

1.25

0.16, 2.34

0.03

C

Model B + hemoglobin A1c

1.47

-0.06, 3.00

0.06

D

Model C + creatinine + body mass index

1.33

-0.28, 2.94

0.10

E

Insulin+UA1+months between UA1 & UA2

1.25

0.18, 2.33

0.02

 

 

 

 

Addition of relevant medications

β

95% CI

P

F

Model D + Allopurinol

1.36

-0.12, 2.84

0.07

G

Model D  + Hydrochlorothiazide

1.41

-0.17, 2.99

0.08

H

Model D + Losartan

1.45

-0.07, 2.96

0.06

I

Model D + Tacrolimus

1.48

-0.04, 3.00

0.06

J

Model D + Cyclosporine

1.61

0.03, 3.20

0.05

β= beta co-efficient from linear regression model, represents the change in uric acid among insulin initiators compared to matched non-initiators; 95% CI=95% confidence interval; UA1=1st uric acid measurement; UA2= 2nd uric acid measurement


Disclosure:

L. MacFarlane,
None;

C. C. Liu,
None;

D. H. Solomon,

Pfizer Inc,

2,

Amgen,

2,

Lilly,

2,

Corrona,

2,

UpToDate,

7.

  • Tweet
  • Email
  • Print

« Back to 2014 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effect-of-initiating-pharmacologic-insulin-on-serum-uric-acid-levels-in-patients-with-diabetes/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

ACR Pediatric Rheumatology Symposium 2020

© COPYRIGHT 2022 AMERICAN COLLEGE OF RHEUMATOLOGY

Wiley

  • Home
  • Meetings Archive
  • Advanced Search
  • Meeting Resource Center
  • Online Journal
  • Privacy Policy
  • Permissions Policies