Diabetes-Friendly Gout Management Strategies

by Jessica Pyhtila, PharmD, BCPS, BCGP

Gout and diabetes often go hand in hand. Diabetes is a risk factor for developing gout. Further, conditions that often accompany diabetes like obesity, high blood pressure, and poor kidney function can also increase the risk of gout. Many dietary, medication and lifestyle strategies for managing gout are available, but it can be hard to tell which ones can impact your diabetes control. Our guide to diabetes-friendly gout strategies can help you manage both your diabetes and gout successfully.

Diabetes-Friendly Gout Medications

Gout medications are often divided into two categories: those that help prevent gout flares, and those that treat gout flares.

Medications that help prevent gout flares often work by lowering uric acid, the substance that is responsible for gout flares. Most gout prevention medications are safe for use in diabetes with some exceptions. These include febuxostat (Uloric), which carries an FDA Black Box Warning for increasing the risk of cardiovascular death. For this reason, those at risk of cardiovascular disease – including those with diabetes – often require an alternate medication. Pegloticase (Krystexxa) is an intravenous medication for gout management that requires premedication with steroids that can drive up your blood sugars. Other options that may be safer in diabetes include:

·         Allopurinol (Aloprim, Zyloprim): This once-daily drug is commonly used in gout and is well-tolerated. Those with kidney disease, which is common in diabetes, may need a lower dose than those without kidney disease.

·         Probenecid: This medication is taken twice daily to prevent gout flares. It should not be used in those with severe kidney disease.

·         Lenisurad: This medication is meant to be used alongside other medications like allopurinol, as it can cause kidney failure when used alone. Further, it should be avoided if you have severe kidney disease.

Gout flares are treated by several classes of medications including non-steroidal anti-inflammatory drugs (NSAIDs), steroids, and colchicine. Steroids, whether taken by mouth or injected directly into the affected joint, can increase your blood sugar by up to 68%. For this reason, if your doctor has prescribed you a course of steroids to treat a gout flare, you may need to intensify your diabetes regimen during that time. You should ask your doctor if an alternative to a steroid is appropriate for you, or how best to manage your blood sugar if you need to remain on the steroid during your gout flare. Other treatment options for gout flare that have less impact on your blood sugar than steroids include:

·         NSAIDS: NSAIDs including ibuprofen and naproxen are given at the first sign of a gout flare and continued until the flare ends. Doctors generally prescribe higher doses of NSAIDs than are available over the counter, or choose strong prescription-only NSAIDs to combat the pain and inflammation from a gout flare. Although many people can safely take an NSAID for a few days, the drug may need to be avoided if you have certain health conditions, including heart failure.

·         Colchicine (Colcrys): Colchicine is an antigout drug that is taken at the first sign of a gout flare and is generally continued for several days until the flare resolves. It works by interfering with neutrophils, a type of blood cell that impacts some gout symptoms. Nausea, vomiting and diarrhea are the most common side effects from the drug: for this reason, monitoring your blood sugar is important, especially if the side effects impact your food intake or hydration. The drug can be safely used in most people, however should generally be avoided if you have serious kidney or liver problems.

It is also important to realize that some medications can increase the level of uric acid in your blood, contributing to the risk of gout flares. These include both aspirin and niacin, which is available both over-the-counter and as a prescription. Diuretics, sometimes called “water pills” like furosemide (Lasix) can also increase uric acid.

Diabetes-Friendly Dietary Changes for Gout Control

As soon as you get a gout diagnosis, your doctor will often advise you about dietary changes to avoid future painful flares. These changes usually include avoiding red meat, organ meat, and alcohol. However, you can make many dietary changes that benefit both your blood sugar control as well as your gout. One such change is eating according to the heart-healthy DASH diet, which has been linked to a lower risk of gout. The DASH diet has goals like:

·         Consuming fruits and vegetables

·         Eating whole grains like brown rice

·         Eating low-fat or no-fat dairy products

·         Getting protein from poultry, beans, and fish (note however that tuna, salmon and trout can increase your gout risk)

·         Getting healthy fats from nuts and vegetable oils like olive oil

Beverages are also important when it comes to both diabetes and gouts. Diabetes-friendly beverage tips for keeping your blood sugar at goal and your joints free of gout include:

·         Increasing your water intake: This can help to flush both uric acid and sugar from your system

·         Avoiding alcohol: Besides impacting your blood sugar, alcohol can increase your risk of a gout flare

·         Avoiding sugary soda and fruit juice: The fructose and high fructose corn syrup in sugary beverages can spike your blood sugar and increase your risk of gout. The sweetening additive xylitol likewise can increase your risk of gout flares.

Diabetes-Friendly Lifestyle Changes for Gout Management

Obesity is a risk factor for both Type 2 diabetes as well as gout. Strategies to help you lose weight, conversely, can help you control both your blood sugar and your gout risk. That said, surgical methods for weight loss like bariatric surgery can increase your risk of gout flares in the short term, although they can benefit both blood sugar control and weight in the long-term. Your doctor can advise you about your weight goals, and if weight-loss is right for you to help you control your diabetes and gout.

References:

Centers for Disease Control and Prevention. “Gout.” July 27, 2020. Retrieved from: https://www.cdc.gov/arthritis/basics/gout.html

Tamez-Pérez, Héctor Eloy; Quintanilla-Flores, Dania Lizet; Rodríguez-Gutiérrez, René. “Steroid hyperglycemia: Prevalence, early detection and therapeutic recommendations: A narrative review.” World Journal of Diabetes. July 25, 2015. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515447/

Drugs.com. “Uloric.” February 1, 2019. Retrieved from: https://www.drugs.com/pro/uloric.html

Drugs.com. “Lenisurad.” July 17, 2020. Retrieved from: https://www.drugs.com/ppa/lesinurad.html

McMillen, Matt. “DASH Diet May Lower Gout Risk.” Diabetes Forecast, July 2017. Retrieved from: http://www.diabetesforecast.org/diabetes-discovery/pi/gout-and-dash-diet.html

National Heart, Lung, and Blood Institute. “DASH Eating Plan.” N.d. Retrieved from: https://www.nhlbi.nih.gov/health-topics/dash-eating-plan

Arthritis Foundation. “Gout Diet: Dos and Don’ts.” N.d. Retrieved from: https://www.arthritis.org/health-wellness/healthy-living/nutrition/healthy-eating/gout-diet-dos-and-donts

Salem, C. Ben; Slim, Raoudha; Fathallah, Neila; Hmouda, Houssem. “Drug-induced hyperuricaemia and gout.” Rheumatology, May 2017. Retrieved from: https://academic.oup.com/rheumatology/article/56/5/679/2631573

Nielsen, Sabrina M.; Bartels, Else M.; Henriksen, Marius; et al. “Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies.” Annals of the Rheumatic Diseases, 2017. Retrieved from: https://ard.bmj.com/content/76/11/1870

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