Adherence to gout treatment guidelines in patients with diabetes: A Danish prospective cohort study with 4 years of follow-up.

Abstract

Aims: Diabetes affects about 6 % of the global population, with 20 % developing foot ulcers. Gout impacts approximately 3 %, but fewer than 40 % receive adequate urate-lowering therapy to prevent or dissolve tophi in the feet. This study assessed adherence to recommended gout treatment in patients with diabetes.

Methods: From a prospective cohort of gout patients, confirmed by microscopy-identified urate crystals, we identified those with concomitant diabetes. Patients were treated in various real-life healthcare settings. The primary outcome was achieving target serum urate levels four years post-diagnosis: < 0.36 mmol/L for general gout management and < 0.30 mmol/L for tophi patients.

Results: Of 286 gout patients, 85 (30 %) had diabetes. The median age was 71 years, and 76 % were male, with common comorbidities. Urate levels sufficient to prevent new tophi were maintained by 58 %. However, 45 % had tophi at diagnosis, and only 46 % of these achieved levels low enough to dissolve tophi.

Conclusions: Gout in patients with diabetes is often inadequately managed, potentially leading to persistent tophi, which may ulcerate and contribute to foot ulcers. These findings likely reflect typical treatment settings. Affordable and effective gout treatment could prevent tophi formation and improve outcomes. Consideration of gout screening in diabetes management guidelines is recommended.