Research Progress of Traditional Chinese and Western Medicine on Gout Complicated with Diabetes Mellitus

Guoqing ZHAO, Lamei ZHOU

Wuxi Hospital of Traditional Chinese Medicine, Wuxi 214000, China

Abstract At present, there is a certain understanding of gout combined with diabetes in traditional Chinese medicine, but most studies are related to diabetes combined with hyperuricemia, while few studies are related to gout combined with diabetes. In this paper, the research progress of western medicine in the treatment of gout combined with diabetes is summarized and the research progress of Chinese medicine or integrated Chinese and western medicine in the treatment of gout combined with diabetes is explored.

Key words Gout, Type 2 diabetes, Research progress

1 Introduction

Gout refers to arthropathies associated with urate crystals, with a prevalence of 1%-3%[1], and its pathogenesis is directly related to hyperuricemia. Diabetes is one of the common diseases in modern life. According to the survey, the prevalence of diabetes in people aged 18 and above is 11.7%[2], and the incidence of hyperuric acid in people with type 2 diabetes is 19%[3]. China has a large population base, but there is not much research on gout combined with diabetes, so it is particularly important to prevent and cure gout combined with diabetes. Its related research has always been the focus of medical workers.

2 Progress in western medicine research

2.1 EpidemiologyLiu Hongetal.[4]analyzed the clinical characteristics of 893 young patients with gout and showed that the prevalence of diabetes in middle-aged and elderly patients was higher than that in adolescents. Dong Xiaomeietal.[5]showed that diabetes and gout are mutual risk factors. Gout and diabetes predate each other’s peak by 10 years, with a higher and steeper incidence curve. The risk of developing type 2 diabetes was 3.3-fold higher in the group with the highest blood uric acid than in the group with the lowest blood uric acid[6]. Chang Zheng[7]found that the risk of diabetes in women with high uric acid increased by 109. 6%, while the risk of diabetes in men was unrelated. These findings suggest that increased uric acid levels in elderly women are associated with an increased risk of diabetes.

2.2 PathogenesisIt is believed that the physiological and pathological basis of gout is elevated blood uric acid, and impaired glucose regulation is pre-diabetes, in modern medicine. The etiology and pathogenesis of diabetes are mainly insulin resistance and damage of islet β cells, and abnormal metabolism of blood uric acid can increase insulin resistance and damage islet β cells[8]. Liang Cuicui[9]showed that there was significant insulin resistance in patients with gout, with compensatory increase of islet β cell secretion, which was manifested as increased FINS level, arginine stimulation, increased AUC of first and second phase insulin secretion after glucose stimulation, and increased peak insulin secretion. Duan Ruifeng[10]believed that the level of insulin sensitivity index in male patients with type 2 diabetes combined with gout was relatively low, which was significantly correlated with patients’ age, BMI,etc., and significantly correlated with adiponectin and CRP levels.

2.3 Lipid metabolism index and cardiovascular diseaseXu Weietal.[11]divided patients with type 2 diabetes complicated with gout, type 2 diabetes and gout patients into groups 1, 2 and 3, respectively, and five biochemical indexes of patients in the three groups were measured, including uric acid (UA), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C), and found that the biochemical index of TC, TG, LDL-C and HDL- C had a close correlation with type 2 diabetes combined with gout, using ROC curve. Sui Miaoetal.[12]analyzed the relationship between serum uric acid level and carotid atherosclerosis in elderly patients with T2DM, and concluded that uric acid is an independent risk factor for the occurrence of male atherosclerosis. Liu Yuanetal.[13]showed that the correlation between serum uric acid level and epicardium adipose thickness (EAT) in patients with T2DM indicated that SUA level was positively correlated with EAT level in patients with T2DM, and age and elevated SUA level were risk factors for the occurrence of EAT thickening. Li Minetal.[14]showed that the concentration of oxidixed low-density lipoprotein (ox-LDL) and the level of inflammatory factors in male patients with gout combined with abnormal glucose tolerance were significantly increased. Yang Miaoetal.[15]found that blood uric acid levels are strongly associated with a 10-year risk of coronary heart disease, and asymptomatic hyperuricemia may be one of the independent risk factors for coronary heart disease in Chinese type 2 diabetic patients.

2.4 Influence on the course of diseaseWang Ningetal.[16]compared the general conditions and arthritis of gout alone group and patients with gout combined with T2DM and showed that the acute period of patients with gout complicated with T2DM was longer, the inflammatory response (ESR, CRP) and cartilage injury were more serious (LDL-C and CTX-II levels), and the increase of various inflammatory indicators (IL-1β, TNF-αIL-1β, TNF-α) was positively correlated with the increase of mean HbA1C.

2.5 Treatment

2.5.1Education and diet control. Huang Xiujuanetal.[17]implemented health education on gout knowledge and applied it to the nursing of patients with type 2 diabetes complicated with hyperuricemia, which played an important role in the improvement of patients’ blood glucose and uric acid levels. Lei Yinpingetal.[18]adopted conventional diet in the control group, and dietary intervention was applied in the observation group on the basis of the control group. The satisfaction and clinical efficacy of the two groups were compared and analyzed. The results showed that dietary intervention has obvious clinical effect on the treatment of elderly type 2 diabetes with gout, can reduce the incidence of adverse reactions in patients, and improve the satisfaction of patients. Cui Haishan[19]conducted a randomized controlled study on 60 patients, showing that dietary intervention can not only improve patient satisfaction, but also improve the pH value of blood gas analysis in ICU patients and shorten the length of stay.

2.5.2Drug treatment. Shang Xueyingetal.[20]applied fenbuxostat or febuxostat in the treatment of patients with type 2 diabetes complicated with hyperuricemia, indicating that both febuxostat and febuxostat can effectively reduce the level of blood uric acid and improve patients’ blood glucose in patients with type 2 diabetes complicated with hyperuricemia. Benzbromarone can improve the level of C peptide after meal. Ding Shuanghuietal.[21]showed that daglixin can reduce uric acid and blood glucose levels in patients with type 2 diabetes complicated with hyperuricemia.

3 Research progress of traditional Chinese medicine

3.1 Research of syndrome differentiationTreatment based on syndrome differentiation is the basic idea of traditional Chinese medicine. At present, there is no unified standard for the syndrome differentiation of diabetes with gout. Luo Zheng[22]found that patients with type 2 diabetes complicated with hyperuricemia have serious complications. The syndromes of Chinese medicine are mainly deficiency of qi and yin, deficiency of yin and fire, stagnation of heat in the liver and stomach, and phlegm, blood stasis and turbidity. Yang Xueju[23]analyzed the patients’ physique and showed that for type 2 diabetes patients with hyperuricemia, phlegm dampness, dampness and heat, and yin deficiency were the main pathogenesis. Zhang Qiuju[24]believed that phlegm turbidity and blood stasis, as pathological products, ran through the whole disease process and were both problems. Wu Yongyanetal.[25]divided patients with gout complicated with type 2 diabetes into four types: dampness-heat accumulation, dampness-obstruction of spleen deficiency, cold dampness-obstruction group, phlegm and stasis obstruction group, and phlegm and stasis obstruction group, and found that the levels of uric acid in patients with phlegm and stasis obstruction syndrome were higher than those in the other three groups, the levels of hs-CRP and erythrocytic sedimentation rate in patients with damp-heat accumulation syndrome were higher than those in the other three groups, and the levels of HbA1c in patients with spleen deficiency and dampness obstruction were higher than those in the other three groups.

3.2 Treatment based on syndrome differentiationLiu Fangling[26]showed that the total effective rate of the traditional Chinese medicine group in the treatment of type 2 diabetes complicated with hyperuricemia was significantly improved compared with that of the western medicine group by meta analysis. Xie Junetal.[27]found that in clinical practice, the syndrome of wet blood and blood stasis was still the majority, and the application of Angelica Niantong Decoction in the treatment of type 2 diabetes combined with the syndrome of painful rheumatism and blood stasis achieved a good clinical effect. Yin Yuanetal.[28]showed that on the basis of oral medications, the control group was treated with benbromarone tablets and sodium bicarbonate tablets to carry out hypouricemic treatment, and the treatment group was treated with Bi Xie Gout Prescription, after 12 weeks of treatment, the curative effect and fasting blood uric acid of the two groups were observed, the fasting blood uric acid and blood glucose in the treatment group were lower than those in the control group, the clinical efficacy of integrated traditional Chinese and Western medicine in the treatment of type 2 diabetes mellitus complicated with gout was significantly better than that of Western medicine alone.

3.3 Experimental studyZhou Yuanyuanetal.[29]divided rats with gout complicated with diabetes into Bi Ling Formula group, indomethacin group and pioglitazone group. The study showed that Bi Ling and indomethacin groups significantly reduced blood glucose and blood uric acid, indicating that Bi Ling can help restore body weight, reduce blood glucose and blood uric acid levels, and significantly inhibit the high expression of PGE2 and COX-2. Xie Weici[30]found that TG, TC and LDL-C were also decreased in the Bi Ling group and pioglitazone, indicating that Bi Ling has a good effect on lowering blood glucose, regulating lipid and lowering blood uric acid, and the mechanism of which may be related to the intervention on the high expression of HMGB1 and FoxO3 in the kidney of diabetic gout rats.

4 Conclusions

In conclusion, the number of patients with gout combined with type 2 diabetes is gradually increasing, and has the characteristics of prolonged and difficult to cure, which faces certain challenges in clinical treatment. Therefore, the prevention and treatment of diabetes with gout is very important. At present, Chinese medicine has a certain understanding of diabetes with gout, and the adverse reactions of traditional Chinese medicine are relatively small. In the future, we will explore the treatment of gout with traditional Chinese medicine or integrated Chinese and Western medicine, so as to make greater progress in the treatment of traditional Chinese medicine.