When hyperuricemia meets diabetes, what should you do?

This is the 3704th article of Da Yi Xiao Hu

Hyperuricemia and diabetes are both metabolic diseases. They share a common basis for onset—overnutrition. They are both clearly associated with insulin resistance and are risk factors for cardiovascular disease. Since hyperuricemia is often associated with risk factors such as diet and alcohol intake, which are also related to the occurrence of diabetes, it is difficult to clarify the causal relationship between the two.

Hyperuricemia refers to the fasting blood uric acid level of men>420μmol/L (7mg/dl) and women>360μmol/L (6mg/dl) when tested twice at different times under normal dietary conditions; gout is a metabolic disease. Due to the deposition of urate crystals in joints, soft tissues and kidneys, it causes arthritis, skin lesions and kidney damage. The two are different states of the same disease. Diabetes is a group of metabolic diseases caused by disorders of human sugar metabolism, with high blood sugar as the main sign.

Here comes the problem~~ If you suffer from hyperuricemia and diabetes at the same time, the treatment may be caught in a dilemma: diabetes treatment requires more exercise, while active arthritis caused by hyperuricemia restricts excessive exercise; diabetes advocates a high-protein, low-calorie diet (ketogenic diet), while hyperuricemia strictly controls meat intake, etc.; certain hypoglycemic drugs may affect purine metabolism, etc.

How to treat hyperuricemia when it meets diabetes?

1. Adjust the diet structure and control the total calories of the diet

A low-purine, low-fat and low-salt diet is recommended.

1) Low-carb diet

Controlling staple foods is beneficial to controlling blood sugar.

2) Eat more fruits and vegetables rich in dietary fiber, Vit B1 and Vit C

Effectively prevent and control gout, dietary fiber can increase insulin sensitivity. Regular consumption of fresh vegetables is a protective factor for gout.

(1) Lemons, cherries, olives, etc. are beneficial for gout patients.

(2) Watermelon, coconut, grapes, strawberries, plums and peaches can be eaten in moderation.

(3) The vast majority of melons, tubers, roots and most leafy vegetables are low-purine foods and are recommended for consumption.

(4) Avoid eating too much plant-based foods with high purine content, such as shiitake mushrooms, straw mushrooms, asparagus, seaweed, kelp, and grain germs.

(5) Reduce the intake of high-fructose fruits and vegetables: Some fruits (apples, bananas, figs, pears, oranges, longans, lychees, grapefruits, persimmons and pomegranates, etc.) and vegetables (beets, lotus roots, water chestnuts, etc.) contain high levels of fructose.

(6) Avoid drinking: Alcohol is one of the risk factors for gout attacks. Drinking alcohol causes elevated uric acid levels through various pathways and also affects the body's sensitivity to insulin. Studies have shown that beer and strong alcohol increase the risk of gout attacks.

3) Drink plenty of water

The Gout Diagnosis and Treatment Guidelines recommend that increasing water intake can be used as one of the non-drug treatment measures for gout patients. In the absence of contraindications such as kidney disease and heart failure, gout patients are advised to drink water:

(1) The total amount of water you drink per day is 2 to 3 liters.

(2) Drink water in batches. It is recommended to drink about 500 ml of water three times in the morning, afternoon and evening.

(3) Try to choose weakly alkaline, small molecule water as drinking water.

(4) Studies have shown that drinking lemon water (such as 1 to 2 fresh lemon slices added to 2 to 3 L of water) can help lower uric acid.

(5) Soft drinks should be avoided regardless of whether you have hyperuricemia or diabetes.

4) Gout patients should pay attention to the type, quantity and processing method of animal foods when eating them

(1) Types: Avoid eating animal offal such as liver, kidney, heart, intestines, etc., as their purine content is higher than that of ordinary meat. You can choose to eat milk, eggs and appropriate amounts of non-mammalian meat (including chicken, duck, goose and some freshwater fish) with lower purine content. The meat you eat should be mainly lean meat.

(2) Quantity: It is generally believed that gout patients should not consume more than 100g of meat per day. (During the acute stage of gout, all meat should be avoided.)

(3) The processing method is very important. Cooking methods such as pickled or smoked meat, deep-frying, pan-frying, braising or hot pot are not recommended. Eat fresh meat as much as possible, and it is recommended to boil it in water and discard the soup before eating. At the same time, avoid using too much salt, sugar and spice seasonings.

2. Choose drugs that have little effect on uric acid

1) Hypoglycemic drugs: Insulin and sulfonylureas (glimepiride, gliclazide) have certain effects on uric acid, and the use of the above drugs should be weighed.

2) Diuretics: Thiazide diuretics (hydrochlorothiazide) and loop diuretics (furosemide) affect uric acid excretion and can induce hyperglycemia, while potassium-sparing diuretics (spironolactone, triamterene) promote uric acid excretion.

3) Antihypertensive drugs: Angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) can reduce insulin resistance. ARB has the effect of lowering uric acid. ARB is the first choice for antihypertensive drugs for patients with hyperuricemia and diabetes.

4) Glucocorticoids: Glucocorticoids increase weight and cause insulin resistance. They should be avoided when gout attacks.

3. Weight management

Adipose tissue can produce and secrete more uric acid and increase insulin resistance. Body mass index is positively correlated with the incidence of gout. Abdominal obesity can also increase the risk of gout. Weight loss can reduce blood uric acid levels and is beneficial for reducing gout attacks.

4. Regular and moderate exercise

Low-intensity aerobic exercise can reduce the incidence of gout, while moderate to high-intensity exercise may reduce uric acid excretion and increase blood uric acid levels, which in turn increases the incidence of gout. Appropriate exercise can be used as one of the non-drug treatment measures.

Movement principles

1) Patients with hyperuricemia are advised to exercise regularly.

2) Gout patients should start with low-intensity exercise and gradually transition to moderate intensity, avoiding strenuous exercise. In the acute stage of gout, rest is the main method, and interrupting exercise is conducive to the subsidence of inflammation.

3) It is advisable to exercise 4 to 5 times a week, each time for 0.5 to 1 hour. You can choose jogging, Tai Chi, etc.

4) During or after exercise, you should drink enough water to promote uric acid excretion. However, you should avoid drinking a lot of water quickly to avoid adding burden to your body.

5) People with underlying cardiovascular or lung diseases should moderately reduce exercise intensity and shorten exercise time.

References

【1】Huang Yefei, Yang Kehu, Chen Shuhong, et al. Practice guidelines for patients with hyperuricemia/gout[J]. Chinese Journal of Internal Medicine, 2020, 59(7): 519-527.

【2】Chinese Society of Rheumatology. 2016 Chinese Gout Diagnosis and Treatment Guidelines[J]. Chinese Journal of Internal Medicine, 2016, 55(22):892-899.

Author: Huangpu Branch of the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine

Qiu Wei, Deputy Director of Nursing Department, Head Nurse

Endocrinology Department Chief Physician An Zengmei

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