Insulin resistance syndrome and impaired glucose homeostasis in patients with gout

Abstract

Background. According to the results of population stu­dies, hyperuricemia (HU) was recognized as a risk factor for insulin resistance (IR) and type 2 diabetes mellitus (DM). It was found that an increase in serum uric acid concentration by 1 mg/dL leads to a 17% increase in the risk of type 2 DM. The aim is to study the features of the manifestations of IR syndrome in patients with gout, its connection with HU and joint damage to establish a chronological relationship between individual components of metabolic syndrome (MS) and the development of chronic gouty arthritis. Materials and methods. Ninety-two patients with gout and MS were examined. Three groups of male patients were formed: group 1 (n = 11) — with the HOMA-IR index ≤ 2.7 units; group 2 (n = 13) — with the HOMA-IR index > 2.7 units; group 3 (n = 25) — with type 2 DM. The comparison group consisted of patients with MS without gout (n = 46). Results. The incidence of MS in gout patients was 78.3 %. Type 2 DM was diagnosed in every second patient with gout and in every 15th patient with MS. For patients with gout in the absence of IR and impaired glucose homeostasis, an intermittent course of the disease with alternating rare joint attacks and long periods of remission was typical; for patients with IR and type 2 DM — a severe chronic course of the disease with a high level of uricemia, frequent protracted joint attacks involving more joints. The presented mathe­matical models of approximation indicate more striking deviations in the parameters of glucose homeostasis in patients with gout, IR and type 2 DM, compared to those with gout and without IR and impaired glucose homeostasis, who require the involvement of more complex compensatory mechanisms aimed at maintaining them. Conclusions. In patients with gout, the level of uricemia and the period of HU duration determine the variance of glucose homeostasis parameters and act as predictors for the development of its disorders.