Diabetes and gout have a bidirectional relationship, which means that each condition influences the other.
“The two conditions have a common upstream risk factor, which is obesity,” says Stephen P. Juraschek, MD, PhD, a gout researcher and an associate professor of medicine at Beth Israel Deaconess Medical Center in Boston. “We know that a higher BMI and obesity is associated with diabetes and is strongly associated with gout.”
Additionally, metabolic syndrome is also common with these two conditions. Metabolic syndrome is a group of warning signs, including high blood pressure, abdominal obesity, hyperglycemia, and unhealthy cholesterol levels, that collectively indicate a higher risk for life-threatening illnesses.
According to gout researcher Youssef M. Roman, PharmD, PhD, an associate professor of pharmacy practice and administrative sciences at Idaho State University in Pocatello, gout may also be related to insulin resistance. Higher amounts of insulin in your blood caused by insulin resistance is called hyperinsulinemia.
“Hyperinsulinemia, a hallmark of type 2 diabetes, can have major effects on the expression of multiple genes responsible for uric acid disposition,” says Dr. Roman.
Despite the obvious overlap, the relationship between gout and diabetes isn’t completely understood. Roman says it can be difficult to tell exactly which one leads to or causes the other. One study suggested diabetes could be associated with increased serum urate levels. Another study found that developing diabetes at a younger age was associated with early gout development. To confuse things further, other research suggests that diabetes may protect against gout.
“Studies that have looked at diabetes duration over time have shown that gout risk trends downward a little bit and the mechanisms for this are not entirely clear,” says Dr. Juraschek.
Juraschek says there is bidirectionality between the two because of metabolic syndrome, “but I’m not sure I would say that uric acid is explicitly causing diabetes or diabetes is acting directly on gout.”
If you do have both conditions, talk to your doctor about harmonizing your treatments so you can treat each condition without making the other worse.
