Purpose To assess the risk of diabetic retinopathy (DR), vision-threatening complications (VTCs), and ocular interventions in patients with diabetes stratified by gout status, and to evaluate the potential protective effect of urate-lowering therapy (ULT). Methods This retrospective cohort study utilized the TriNetX Health Research Network. Patients with type 2 diabetes mellitus were identified using ICD-10 codes and stratified by the presence or absence of gout. Patients with less than one year of follow-up, pre-existing DR, or confounding ocular conditions were excluded. Propensity score matching was performed for demographics, systemic comorbidities, body mass index, and medications. Primary outcomes included the development of nonproliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), vitreous hemorrhage (VH), diabetic macular edema (DME), tractional retinal detachment (TRD), neovascular glaucoma (NVG), and the need for intravitreal injections (IVI), panretinal photocoagulation (PRP), and pars plana vitrectomy (PPV) at one, three, and five years. A secondary analysis evaluated gout patients with severe NPDR or PDR stratified by ULT use. Results After matching, 21,707 patients were analyzed in each cohort. The gout cohort had significantly higher risks of NPDR (RR: 8.31, 95% CI: 6.25–11.36, p < .0001), PDR (RR: 1.75, 95% CI: 1.22–2.41, p = .0015), VH (RR: 5.83, 95% CI: 3.79–8.99, p < .0001), DME (RR: 6.94, 95% CI: 4.96–9.71, p < .0001), and NVG (RR: 3.90, 95% CI: 2.35–6.45, p < .0001) at five years. The gout cohort also required more IVI (RR: 2.88, 95% CI: 2.21–3.75, p < .0001), PRP (RR: 7.60, 95% CI: 3.93–14.69, p < .0001), and PPV (RR: 4.00, 95% CI: 2.00–8.00, p < .0001). In the secondary analysis (3,425 patients per cohort), ULT was associated with lower risks of VH (RR: 0.59, 95% CI: 0.42–0.84, p = .0025), DME (RR: 0.81, 95% CI: 0.70–0.94, p = .0045), PPV (RR: 0.44, 95% CI: 0.21–0.91, p = .02), and IVI (RR: 0.78, 95% CI: 0.58–0.98, p=.02). No significant differences were observed for TRD in either analysis. Conclusion Gout in patients with diabetes is associated with significantly higher risks of DR, VTCs, and need for ocular interventions. ULT may reduce VTC risk and the need for certain interventions. Prospective trials are needed to confirm these findings.

Gout and diabetic retinopathy: elevated risks and the protective role of urate-lowering therapy

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2026年8月5日

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Ahmed Abdi,
Ahmed M. Alshaikhsalama,
Angeline L. Wang

摘要

Purpose

To assess the risk of diabetic retinopathy (DR), vision-threatening complications (VTCs), and ocular interventions in patients with diabetes stratified by gout status, and to evaluate the potential protective effect of urate-lowering therapy (ULT).

Methods

This retrospective cohort study utilized the TriNetX Health Research Network. Patients with type 2 diabetes mellitus were identified using ICD-10 codes and stratified by the presence or absence of gout. Patients with less than one year of follow-up, pre-existing DR, or confounding ocular conditions were excluded. Propensity score matching was performed for demographics, systemic comorbidities, body mass index, and medications. Primary outcomes included the development of nonproliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), vitreous hemorrhage (VH), diabetic macular edema (DME), tractional retinal detachment (TRD), neovascular glaucoma (NVG), and the need for intravitreal injections (IVI), panretinal photocoagulation (PRP), and pars plana vitrectomy (PPV) at one, three, and five years. A secondary analysis evaluated gout patients with severe NPDR or PDR stratified by ULT use.

Results

After matching, 21,707 patients were analyzed in each cohort. The gout cohort had significantly higher risks of NPDR (RR: 8.31, 95% CI: 6.25–11.36, p < .0001), PDR (RR: 1.75, 95% CI: 1.22–2.41, p = .0015), VH (RR: 5.83, 95% CI: 3.79–8.99, p < .0001), DME (RR: 6.94, 95% CI: 4.96–9.71, p < .0001), and NVG (RR: 3.90, 95% CI: 2.35–6.45, p < .0001) at five years. The gout cohort also required more IVI (RR: 2.88, 95% CI: 2.21–3.75, p < .0001), PRP (RR: 7.60, 95% CI: 3.93–14.69, p < .0001), and PPV (RR: 4.00, 95% CI: 2.00–8.00, p < .0001). In the secondary analysis (3,425 patients per cohort), ULT was associated with lower risks of VH (RR: 0.59, 95% CI: 0.42–0.84, p = .0025), DME (RR: 0.81, 95% CI: 0.70–0.94, p = .0045), PPV (RR: 0.44, 95% CI: 0.21–0.91, p = .02), and IVI (RR: 0.78, 95% CI: 0.58–0.98, p=.02). No significant differences were observed for TRD in either analysis.

Conclusion

Gout in patients with diabetes is associated with significantly higher risks of DR, VTCs, and need for ocular interventions. ULT may reduce VTC risk and the need for certain interventions. Prospective trials are needed to confirm these findings.