SAT0358 Diabetes and gout: real-world evidence evaluating patient characteristics, treatment patterns, and health care utilisation
Authors: D.C. Taylor, A.-C. Fu, R. Morlock
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Gout and type 2 diabetes mellitus (T2DM) are common in the United States (US), but little is known about potential associations of T2DM and hyperuricemia/gout with clinical outcomes. This study examined variations in gout severity, management, and health care utilisation among gout patients with and without T2DM. <h3>Methods</h3> Data were assessed from a survey of US physicians and patient chart audits. Participating physicians managed the care of ≥50 patients with gout annually; chart audits were of their last 5 consecutive adult patients with confirmed gout. Gout severity was measured by physician global assessment, flares, organ/joint damage, and tophi. Treatment characteristics, presence of clinician-confirmed T2DM, and socio-demographics were identified. Descriptive and multivariate (stepwise logistic regression) statistics analysed the differences among gout patients with and without clinician-confirmed comorbid T2DM and assessed urate-lowering therapy (ULT) use and gout control. <h3>Results</h3> Overall, 1159 charts of patients with gout were abstracted (246 with T2DM, 913 without T2DM; 81% male; 71% Caucasian); the proportion of patients aged ≥61 with gout was greater for those with T2DM than without T2DM (69% vs 31%; p&lt;0.01). Patients with gout and T2DM had longer mean duration of gout (63 vs 41 months), were more likely to have tophi (37% vs 20%), joint damage (24% vs 13%), and clinician-rated severe gout (27% vs 13%) than those without T2DM (all p&lt;0.01). Patients with gout and T2DM were also more likely to receive ULT than those without T2DM (86% vs 71%; p&lt;0.01), and among those patients with gout and T2DM receiving allopurinol, mean daily doses were not significantly different (321 mg vs 298 mg; p=0.17). Gout patients with T2DM were more likely to have additional comorbidities (cardiovascular disease, kidney disease, COPD, depression, diabetes, hyperlipidemia, hypertension, obesity, prostate problems [men]) and have chronic pain than those without T2DM (all p&lt;0.05). On average, gout patients with T2DM vs. those without T2DM reported more office visits (4.1 vs 3.5), were more likely to have an emergency department visit (17% vs 9%) and were more likely to have a hospitalisation (5% vs 2%) (all p&lt;0.01). In both groups, ULT use was associated with better gout control, but the specific factors predictive of ULT use and disease control varied between those with and without T2DM. <h3>Conclusions</h3> Gout patients with T2DM were more likely to have a greater impact on health system utilisation and spending, with additional comorbidities and more severe gout than those without T2DM. These data suggest that patients with gout and T2DM constitute a less healthy group in need of careful monitoring and more aggressive gout management. <h3>Acknowledgements</h3> This study was funded by Ironwood Pharmaceuticals. <h3>Disclosure of Interest</h3> D. Taylor Shareholder of: Ironwood Pharmaceuticals, Inc., Employee of: Ironwood Pharmaceuticals, Inc., A.-C. Fu Employee of: Ironwood Pharmaceuticals, Inc., R. Morlock Consultant for: Ironwood Pharmaceuticals, Inc.