Question

A patient comes in with uncontrolled type ll diabetes (insulin resistance) and hypertension. After labs show hyperuricemia, the patient is diagnosed with gout. How does insulin resistance and hypertension contribute to hyperuricemia? What medications should be prescribed to control the type ll diabetes, hypertension and gout? Why did you choose the medications you did?

Answer 1

Role of Insulin resistance and hypertension in hyperuricemia:

Uric acid is a breakdown product of purine metabolism, regulated by the enzyme xanthine oxidase. We rely on renal and intestinal secretion of uric acid to maintain homeostasis. Hyperuricemia can arise because of reduced renal or extrarenal excretion or overproduction of uric acid.

Insulin resistance and hypertension in type II diabetic patients has been proved to cause this hyperuricemia, many researchers have proposed that Insulin resistance(IR)inhibits uric acid excretion is through increasing renal tubular sodium reabsorption, inducing hyperuricemia and Febuxostat, a xanthine oxidase inhibitor, was found to be associated with insulin resistance in people with type II Diabetes, in addition increase in blood pressure causes inhibition of uricase enzyme and causes hyperuricemia.

Medications to be prescribed:

Hyperuricemia can be prevented by use of drugs that lower serum uric acid through reduced formation (allopurinol) or increased renal excretion (a uricosuric agent, benziodarone). with allopurinol 400 mg or probenecid reduces blood pressure in hyperuricemic adolescents with early hypertension by 10 mm Hg (systolic). This supports a causative role for hyperuricemia in the early stages of hypertension. The fact that both a uricosuric drug and allopurinol were effective is important. Allopurinol has additional uric acid–independent effects, which may be more important in older adults.

And drug colchicine, used to treat the arthritic condition gout, could potentially reduce complications accompanying such as combination of high blood pressure, high blood sugar and other conditions that increase the risk of heart disease and type 2 diabetes.

Sodium-glucose co-transporter-2 (SGLT2) Inhibitors also known as Gliflozins are given as oral medications.

SGLT2 inhibitors, a relatively new class of type 2 diabetes medication, are used to help lower blood sugar, and may have protective benefits against obesity, heart disease, and hyperuricemia.

SGLT2 inhibitors work by keeping glucose from being absorbed in the kidneys; excess glucose is excreted through the urine, which keeps sugar levels in the blood down.