Gout and Type 2 Diabetes: Why You’re at Increased Risk

About 9 million Americans have gout, a painful form of inflammatory arthritis — and one in four people with gout also have type 2 diabetes, experts speculate. “Gout is a really strong, independent risk factor for type two diabetes,” says Colin C. Edgerton, MD, a rheumatologist at Low Country Rheumatology in Summerville, South Carolina, and the Executive Chairman of the American Rheumatology Network. In fact, the odds of developing diabetes nearly doubles when you have gout, he adds.

“That’s why it’s important for patients to know there’s a connection [between the two conditions] and to be vigilant,” says Dr. Edgerton. Managing your gout may help lower your chances of developing type 2 diabetes and help avoid the many serious complications linked to this type of arthritis.

Here’s what you need to know about both these very common diseases.

What Is Gout?

This type of arthritis causes inflammation in your joints, making them hot, swollen, and tender. Gout attacks are usually sudden and come on at night or first thing in the morning.

About half the time, people first develop gout in their big toe, which becomes so inflamed that even the touch of the sheets can feel painful. But you can develop gout in your ankles, knees, fingers, elbows, and even your spine.

People with gout have high levels of uric acid, which your body produces to break down certain chemicals found in food, known as purines. This excess uric acid forms crystals that build up in your joints and tissues, leading to inflammation. One of the ways doctors diagnose gout is by looking for these deposits of uric acid.

There’s no cure for gout, but with proper treatment, you’ll have fewer flares, or times when inflammation and pain get worse. Left untreated, gout can lead to permanent joint damage and destruction, says Nilanjana Bose, MD, a rheumatologist affiliated with Memorial Hermann Health System in Houston, Texas. That’s not all: “High uric acid can cause heart disease and the deposits of acid can affect the kidneys and cause kidney disease,” she adds.

What Is Diabetes?

According to the U.S. Centers for Disease Control and Prevention (CDC), of the roughly 34 million Americans who have diabetes, 90 to 95 percent have type 2 diabetes, which happens when your body has problems regulating and using blood sugar (glucose) that your cells need to function.

Normally, the hormone insulin from the pancreas regulates glucose levels in the body, but when you have type 2 diabetes, your pancreas produces less insulin and the body also doesn’t respond properly to the amount of insulin being produced. This is known as insulin resistance. That leaves too much sugar in your bloodstream, setting you up for complications. (By contrast, type 1 diabetes is an autoimmune condition in which your pancreas is unable to produce insulin.)

Type 2 diabetes develops slowly, so you can have it for years without noticing any telltale signs, like having to urinate more often, being thirsty all the time, numbness or tingling in the hands and feet, and fatigue as well as blurred vision.

Some people never develop symptoms at all, which is why it’s good to see a doctor at least once a year to get your blood sugar levels. Otherwise, too much blood sugar in your bloodstream can lead to an increased risk of heart problems, kidney damage, nerve damage, glaucoma, and even Alzheimer’s disease.

Risk Factors for Gout and Type 2 Diabetes

There are several factors that may increase your chances of getting either gout or type 2 diabetes, or both. They include:

Obesity and/or being overweight

Excessive weight ups the odds of developing either condition as well as both. “Much of the insulin resistance that you see in people with type 2 diabetes is related to obesity; it’s the adipose [fat] cells that release the chemical factors that lead to insulin resistance, with some exceptions,” says Dr. Edgerton. So even a slightly overweight gout patient with a lot of belly fat might be at higher risk for developing diabetes than someone who’s more pear-shaped. Having belly fat is dangerous because this type of fat (called visceral fat) can surround internal organs, increasing your risk of heart disease, diabetes, liver problems, and certain types of cancer.

High blood pressure

This is another condition associated with both gout and diabetes. According to Johns Hopkins Medicine, more than 70 percent of people with gout have high blood pressure. The DASH diet (Dietary Approaches to Stop Hypertension) — created to lower blood pressure — is of great interest to gout researchers, as some studies show that it may modestly help lower uric acid levels.

Kidney damage

Known as renal insufficiency, kidneys that don’t work well to flush out waste can affect both gout and diabetes. Having diabetes can result in damage of the blood vessels in your kidneys due to high blood sugar. When you have gout, excess uric acid in your blood can build up and form urate crystals in your kidneys, leading to damage and scars.

But there’s a twist: Kidney damage can also be a result of both diseases, says Dr. Edgerton. “Whereas hypertension and obesity tend to exist more independently of the diagnoses, renal insufficiency is the direct damage that both conditions can cause,” he explains.

Family history

Both gout and diabetes are known to run in the family, so you have a higher chance of developing either if one of your parents or siblings has the disease too.

Age and sex

Both gout and diabetes tend to strike middle-aged and older people. Men are more likely to get gout than women. When women develop gout, it’s typically after menopause. But female gout patients are more likely to develop diabetes, as are older men and women with gout as the risk rises with age, according to a study in the journal of Arthritis & Rheumatology.

Unhealthy lifestyle habits

If you’re not that active, you may gain weight, which may increase the chances of developing either or both gout and diabetes. Too much alcohol and/or sugary drinks, which can increase blood sugar in the system, can also increase your risk of developing both conditions.

How Are Gout and Diabetes Linked?

Doctors don’t know for sure. “It’s frustrating because the association between the two is reliably found in all sorts of populations, but why exactly the two are associated hasn’t been worked out,” Dr. Edgerton notes. But there are some theories:

Metabolic syndrome

Metabolic syndrome is a group of conditions that occurs together. It includes high blood pressure, cholesterol, and blood sugar levels, as well as belly fat. About 50 percent of gout patients have metabolic syndrome, according to Korean researchers.

“We think that gout goes hand in hand with metabolic syndrome,” says Dr. Bose. “So I think patients with gout tend to develop the other components of metabolic syndrome, which are diabetes, hypertension, cholesterol, and elevated BMI.”

Metabolic syndrome could also explain why women with gout are at a higher risk than men, even though more men have gout. Post-menopausal women have a tendency to develop metabolic syndrome, because the sex hormone estrogen plays a role in how cells respond to insulin. “Because of hormonal changes, post-menopausal women may develop insulin resistance and a sluggish response to glucose, and it might explain why some of these women develop diabetes,” says Dr. Bose.

Inflammation

Gout is an inflammatory condition, so it’s producing inflammation in your joints and your body. “If you look at inflammation broadly that could be a linking piece of this all,” says Dr. Edgerton, noting that if gout is causing inflammation in the kidneys, it can exacerbate diabetes.

That’s because the kidneys help you maintain normal blood sugar levels. If they get damaged through inflammation or from poorly controlled gout, they can’t work as well, setting you up for developing diabetes.

High levels of uric acid

People with gout tend to have high levels of uric acid (at least until their gout is treated). And some large-scale studies, including the Framingham Heart Study, which followed several thousand people over many years, have found that patients with high uric acid levels have a higher chance of developing type 2 diabetes as well as metabolic syndrome. This is especially true for women.

But a 2021 study published in Arthritis & Rheumatology didn’t find this relationship — in fact, researchers speculated that insulin resistance led to high uric acid levels and not the other way around.

Treating Gout and Diabetes

Patients need to know that both are chronic diseases — treatable but not curable — so they need to work with their health care providers (rheumatologist, primary care doctor, or endocrinologist) to ensure they are treating both, says Dr. Bose.

By that she means you’re following recommendations for staying on target for blood sugar levels as well as uric acid levels to keep gout flares to a minimum. And that usually involves taking medications to maintain healthy blood sugar levels and healthy uric acid levels.

“Most patients with gout need to be on a medication that lowers their uric acid levels. And type 2 diabetes management depends on ideal control of body mass through diet and exercise as well as medical management of glucose levels,” says Dr. Edgerton.

For gout, that means uric acid-lowering medication like allopurinol or febuxostat. People with type 2 diabetes either take medications to lower their blood sugar levels (like metformin) or to increase insulin production (like a class of drugs known as sulfonylureas). And it’s safe to take medications for both conditions, says Dr. Edgerton.

What might get trickier is following exercise and diet recommendations. To improve blood sugar, you need to be more active, but if you have a gout flare or arthritis, that can be tough, says Dr. Edgerton. And a gout-friendly diet doesn’t totally overlap with a diabetes-friendly one, he adds.

“For example, you might have someone with diabetes being encouraged to kind of do a low-carb or a keto-centric diet. Well, that’s not necessarily going to help with the gout, especially if it’s a high protein diet, which can be more difficult for gout patients.”

Managing Gout and Diabetes

Dr. Edgerton says he always informs his gout patients about the link between gout and diabetes. “They’re both lifestyle-influenced conditions, meaning the changes that have to be made have to be incorporated into a daily activity. It’s not as easy as just taking a pill for either disease,” he notes.

So besides being diligent about getting medical care and following a treatment plan from your primary care doctor and other specialists (such as a rheumatologist for gout or endocrinologist for diabetes), here’s what else may help:

Manage your weight

Fat around the middle (or belly fat) increases the risk of metabolic syndrome. Plus, a healthy weight can help you achieve healthy blood sugar, uric acid, cholesterol levels, and blood pressure — and it’s better for your joints.

Exercise

Start slowly with low-impact workouts that are easier on your joints: “Elliptical, stationary bike, swimming, yoga — it can be 15 minutes, just enough to keep the heart going and the body moving,” says Dr. Bose. Brisk walking is also a good choice, notes Dr. Edgerton.

Limit alcohol

Alcohol can raise both blood sugar and uric acid levels, and may also react poorly with your gout medication. Learn more about the link between gout and alcohol.

Choose healthy foods for both gout and diabetes

The easiest way to think of a gout-friendly diet is to eat less saturated fats and more complex carbs, so more legumes, lean meats (like poultry), and whole grains and less red meat. You also should avoid high-purine foods, like organ meats, and limit shellfish and sardines.

A diabetes-friendly diet is one that includes lean protein, high fiber, whole grains, fruits and vegetables, low-fat dairy, and healthy fats like nuts and olive oil. By eating a nutritious whole foods diet, with plenty of vegetables and a balance of lean protein and whole grains, it’s possible to eat well for both conditions.

Opt for low-fat dairy

Studies show that gout patients who drank low-fat milk or ate low-fat yogurt had fewer flares and lower levels of uric acid.

Go for high-C foods

Vitamin-C rich foods like strawberries, bell peppers, and citrus fruits have been linked to lower uric acid.

Stay hydrated

Being dehydrated can raise the chances of a gout flare and help control blood sugar. That said, what you drink matters. Do your best to stick with water or other non-sweetened beverages. Sugary drinks with high-fructose corn syrup (like soda or iced teas and juices) can increase uric acid and blood sugar levels, and add empty calories.

Sip some coffee

Coffee may reduce uric acid levels, according to some studies, though you have to drink quite a few cups to get that effect. But just two or three cups a day can lower your risk of developing both metabolic syndrome and type 2 diabetes, which sounds more doable. Just be sure not to add sweeteners or syrups.

Adapting healthy lifestyle habits can help you manage gout and prevent diabetes at the same time. This means paying attention to your diet and exercise routine and making sure you have regular checkups, says Dr. Bose. And if you do develop diabetes, don’t beat yourself up.

“Unfortunately, some people have a genetic predisposition for diabetes, then it’s fighting your genes,” she notes. “But even if you develop diabetes, if you’re good about lifestyle, the management of diabetes becomes so much easier.”

Download Our Patient’s Guide to Gout

Whether you are newly diagnosed, have been living with gout for many years, or are caring for someone with gout, it’s easy to feel overwhelmed by the whirlwind of information — and misinformation — available about gout.

Our guide offers comprehensive yet easy-to-understand information on gout and its treatment: what causes gout, how gout can affect your health, how gout is treated, and the steps you can take on your own to prevent flares, manage symptoms, and avoid long-term complications.

Click here to download a Patient’s Guide to Gout for free.