endofocusFOCUS. EndocrinologyFOCUS Эндокринология2713-01772713-0185ООО "Издательство "Перо"10.62751/2713-0177-2026-7-2-07endofocus-212Research ArticleОБЗОРЫThe role of uric acid in the progression of diabetic foot syndrome: Risk factors and treatment approachesРоль мочевой кислоты в прогрессии синдрома диабетической стопы: факторы риска и подходы к терапииhttps://orcid.org/0000-0002-6891-1711НадыбинаМ. Н.NadybinaM. N.

Надыбина Маргарита Николаевна – ассистент кафедры эндокринологии ИКМ 

117513, Россия, г. Москва, ул. Островитянова д. 1 

Scopus Author ID: 57219236724; 

Margarita N. Nadybina – assistant at the Department of endocrinology 

1 Ostrovityanova St., Moscow, 117513  

Scopus Author ID: 57219236724 

mita0098@gmail.comhttps://orcid.org/0000-0002-6826-5924ТепловаА. С.TeplovaA. S.

Теплова Анна Сергеевна – ассистент кафедры

Москва

Anna S. Teplova – assistant of the department of endocrinology

Moscow

anna_kochina_@mail.ruhttps://orcid.org/0000-0003-1276-5484ОболенскийВ. Н.ObolenskiyV. N.

Оболенский Владимир Николаевич – к.м.н., доцент кафедры

Москва  

Vladimir N. Obolenskiy – Cand. Sci. (Med.), associate professor 

Moscow

obolenskii_vn@rsmu.ruРоссийский национальный исследовательский медицинский университет им. Н.И. Пирогова (Пироговский университет)РоссияPirogov Russian National Research Medical UniversityRussian Federation202611072026725462Copyright © Nadybina M.N., Teplova A.S., Obolenskiy V.N., 20262026Надыбина М.Н., Теплова А.С., Оболенский В.Н.Nadybina M.N., Teplova A.S., Obolenskiy V.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://endofocus.elpub.ru/jour/article/view/212

Diabetic foot syndrome (DFS) and gout are interrelated diseases that often accompany diabetes mellitus, where hyperuricemia is a key risk factor for the progression of lower limb damage and systemic disorders. This literature review analyzes the pathogenetic role of uric acid in the development of DFS, emphasizing its effect on inflammation, neuropathy, and amputation risk, while the effect of uric acid on amputations remains poorly understood in the literature. The key mechanisms of hyperuricemia influence on diabetes include excessive intake of purines from food, impaired uric acid transport, activation of proinflammatory pathways that exacerbate diabetic neuropathy and contribute to the chronization of ulcerative defects. Special attention is paid to comorbid conditions such as cardiovascular diseases and chronic kidney disease, which also worsen the outcomes of DFS and increase mortality. The therapy section presents the main modern strategies for reducing uric acid levels. This review emphasizes the need for uric acid screening in all patients with DFS to predict outcomes, personalize therapy, and reduce the risk of amputations.

Синдром диабетической стопы (СДС) и подагра нередко сочетаются у пациентов с сахарным диабетом (СД), при этом гиперурикемия (ГУ) выступает ключевым фактором прогрессирования поражения нижних конечностей и системных нарушений. В данном обзоре литературы представлен анализ патогенетической роли мочевой кислоты (МК) в развитии СДС, освещено ее влияние на воспаление, нейропатию и риск ампутаций (последний пункт остается малоизученным в научной литературе). Ключевые механизмы влияния ГУ на СДС включают избыточное поступление пуринов с пищей, нарушение транспорта МК, активацию провоспалительных путей, усугубляющих диабетическую нейропатию и способствующих хронизации язвенных дефектов. Особое внимание уделено коморбидным состояниям, таким как сердечно-сосудистые заболевания и хроническая болезнь почек, которые также ухудшают исходы СДС и увеличивают летальность. В разделе терапии представлены основные современные стратегии снижения уровня МК. Подчеркивается необходимость скрининга МК у всех пациентов с СДС для прогнозирования исходов, персонализации терапии и снижения риска ампутаций. 

подаграгиперурикемиясиндром диабетической стопымочевая кислотадиабетическая язва стопыgouthyperuricemiadiabetic foot syndromeuric aciddiabetic foot ulcerReferencesAsghari KM, Zahmatyar M, Seyedi F, Motamedi A, Zolfi M, Alamdary SJ, et al. Gout: Global epidemiology, risk factors, comorbidities and complications: A narrative review. BMC Musculoskelet Disord. 2024;25(1):1047. https://doi.org/10.1186/s12891-024-08180-9Asghari KM, Zahmatyar M, Seyedi F, Motamedi A, Zolfi M, Alamdary SJ, et al. Gout: Global epidemiology, risk factors, comorbidities and complications: A narrative review. BMC Musculoskelet Disord. 2024;25(1):1047. https://doi.org/10.1186/s12891-024-08180-9Клинические рекомендации. Идиопатическая подагра. Ассоциация ревматологов России. Рубрикатор клинических рекомендаций Минздрава России. 2025. ID: 936_1. Доступ: https://cr.minzdrav.gov.ru/view-cr/936_1 (дата обращения – 14.03.2026).Clinical guidelines. Idiopathic gout. Rubricator of clinical guidelines of the Ministry of Health of the Russian Federation. Association of Rheumatologists of Russia. 2025. ID: 936_1. URL: https://cr.minzdrav.gov.ru/view-cr/936_1 (date of access – 14.03.2026) (In Russ.).Hesham A, Musab AM, Rashad A, Sherif E. Stepping up to the challenge: Confronting the Global Burden of Diabetic Foot Disease. IntechOpen. Published: 18 September 2025. View: 14 March 2026. [online]. URL: https://www.intechopen.com/chapters/1221841 (date of access – 14.03.2026). https://doi.org/10.5772/intechopen.1012471Hesham A, Musab AM, Rashad A, Sherif E. Stepping up to the challenge: Confronting the Global Burden of Diabetic Foot Disease. IntechOpen. Published: 18 September 2025. View: 14 March 2026. [online]. URL: https://www.intechopen.com/chapters/1221841 (date of access – 14.03.2026). https://doi.org/10.5772/intechopen.1012471Vuorlaakso M, Kiiski J, Salonen T, Karppelin M, Helminen M, Kaartinen I. Major amputation profoundly increases mortality in patients with diabetic foot infection. Front Surg. 2021;8:655902. https://doi.org/10.3389/fsurg.2021.655902Vuorlaakso M, Kiiski J, Salonen T, Karppelin M, Helminen M, Kaartinen I. Major amputation profoundly increases mortality in patients with diabetic foot infection. Front Surg. 2021;8:655902. https://doi.org/10.3389/fsurg.2021.655902Li M, Tang F, Lao J, Yang Y, Cao J, Song R, et al. Multicomponent prediction of 2‐year mortality and amputation in patients with diabetic foot using a random survival forest model: Uric acid, alanine transaminase, urine protein and platelet as important predictors. Int Wound J. 2023;21(2):e14376. https://doi.org/10.1111/iwj.14376Li M, Tang F, Lao J, Yang Y, Cao J, Song R, et al. Multicomponent prediction of 2‐year mortality and amputation in patients with diabetic foot using a random survival forest model: Uric acid, alanine transaminase, urine protein and platelet as important predictors. Int Wound J. 2023;21(2):e14376. https://doi.org/10.1111/iwj.14376Du L, Zong Y, Li H, Wang Q, Xie L, Yang B, et al. Hyperuricemia and its related diseases: Mechanisms and advances in therapy. Signal Transduct Target Ther. 2024;9(1):212. https://doi.org/10.1038/s41392-024-01916-yDu L, Zong Y, Li H, Wang Q, Xie L, Yang B, et al. Hyperuricemia and its related diseases: Mechanisms and advances in therapy. Signal Transduct Target Ther. 2024;9(1):212. https://doi.org/10.1038/s41392-024-01916-yМадянов И. В. Гиперурикемия и сахарный диабет. РМЖ. Медицинское обозрение. 2019;3(1–1):20–24.Madyanov IV. Hyperuricemia and diabetes mellitus. Russkiy meditsinskiy zhurnal. Meditsinskoye obozreniye = Russian Medical Journal. Russian Medical Journal. Medical Review. 2019;3(1–1):20–24 (In Russ.).Куницкая Н.А., Арьев А.Л., Кулаева Н.Н. Роль мочевой кислоты в развитии воспаления при заболеваниях почек. Нефрология. 2023;27(2):39–46. https://doi.org/10.36485/1561-6274-2023-27-2-39-46Kunitskaya NA, Ariev AL, Kulaeva NN. The role of uric acid in the development of inflammation in kidney disease. Nefrologiya = Nephrology (Saint-Petersburg). 2023;27(2):39–46 (In Russ.). https://doi.org/10.36485/1561-6274-2023-27-2-39-46Saito Y, Tanaka A, Node K, Kobayashi Y. Uric acid and cardiovascular disease: A clinical review. J Cardiol. 2021;78(1):51–57. https://doi.org/10.1016/j.jjcc.2020.12.013Saito Y, Tanaka A, Node K, Kobayashi Y. Uric acid and cardiovascular disease: A clinical review. J Cardiol. 2021;78(1):51–57. https://doi.org/10.1016/j.jjcc.2020.12.013Rasmussen C, Larsen JW, Holm PCW, Jepsen ST, Nielsen GL. Adherence to gout treatment guidelines in patients with diabetes: A Danish prospective cohort study with 4 years of follow-up. Prim Care Diabetes. 2025;19(6):613–17. https://doi.org/10.1016/j.pcd.2025.08.006Rasmussen C, Larsen JW, Holm PCW, Jepsen ST, Nielsen GL. Adherence to gout treatment guidelines in patients with diabetes: A Danish prospective cohort study with 4 years of follow-up. Prim Care Diabetes. 2025;19(6):613–17. https://doi.org/10.1016/j.pcd.2025.08.006Zhang X, Zhang X, Li X, Zhao X, Wei G, Shi J, et al. Association between serum uric acid levels and diabetic peripheral neuropathy in type 2 diabetes: A systematic review and meta-analysis. Front Endocrinol (Lausanne). 2024;15:1416311. https://doi.org/10.3389/fendo.2024.1416311Zhang X, Zhang X, Li X, Zhao X, Wei G, Shi J, et al. Association between serum uric acid levels and diabetic peripheral neuropathy in type 2 diabetes: A systematic review and meta-analysis. Front Endocrinol (Lausanne). 2024;15:1416311. https://doi.org/10.3389/fendo.2024.1416311Huang X, Deng L, Huang J, Sun J, Wang Q, Mo J, et al. The ratio of serum uric acid to glycosylated haemoglobin as a predictor of all-mortality in elderly patients with diabetic foot ulcers: A longitudinal cohort study. Diabetes Metab Syndr Obes. 2023;16:2779–90. https://doi.org/10.2147/DMSO.S423017Huang X, Deng L, Huang J, Sun J, Wang Q, Mo J, et al. The ratio of serum uric acid to glycosylated haemoglobin as a predictor of all-mortality in elderly patients with diabetic foot ulcers: A longitudinal cohort study. Diabetes Metab Syndr Obes. 2023;16:2779–90. https://doi.org/10.2147/DMSO.S423017Zhang Y, Tang Z, Tong L, Wang Y, Li L. Serum uric acid and risk of diabetic neuropathy: a genetic correlation and Mendelian randomization study. Front Endocrinol (Lausanne). 2023;14:1277984. https://doi.org/10.3389/fendo.2023.1277984Zhang Y, Tang Z, Tong L, Wang Y, Li L. Serum uric acid and risk of diabetic neuropathy: a genetic correlation and Mendelian randomization study. Front Endocrinol (Lausanne). 2023;14:1277984. https://doi.org/10.3389/fendo.2023.1277984Ye X, Cao Y, Gao F, Yang Q, Zhang Q, Fu X, et al. Elevated serum uric acid levels are independent risk factors for diabetic foot ulcer in female Chinese patients with type 2 diabetes. J Diabetes. 2014;6(1):42–47. https://doi.org/10.1111/1753-0407.12079Ye X, Cao Y, Gao F, Yang Q, Zhang Q, Fu X, et al. Elevated serum uric acid levels are independent risk factors for diabetic foot ulcer in female Chinese patients with type 2 diabetes. J Diabetes. 2014;6(1):42–47. https://doi.org/10.1111/1753-0407.12079Kim HK, Lee M, Lee Y, Lee BW, Cha BS, Kang ES. Uric acid variability as a predictive marker of newly developed cardiovascular events in type 2 diabetes. Front Cardiovasc Med. 2021;8:775753. https://doi.org/10.3389/fcvm.2021.775753Kim HK, Lee M, Lee Y, Lee BW, Cha BS, Kang ES. Uric acid variability as a predictive marker of newly developed cardiovascular events in type 2 diabetes. Front Cardiovasc Med. 2021;8:775753. https://doi.org/10.3389/fcvm.2021.775753Guo Z, Yue C, Qian Q, He H, Mo Z. Factors associated with lower-extremity amputation in patients with diabetic foot ulcers in a Chinese tertiary care hospital. Int Wound J. 2019;16(6):1304–13. https://doi.org/10.1111/iwj.13190Guo Z, Yue C, Qian Q, He H, Mo Z. Factors associated with lower-extremity amputation in patients with diabetic foot ulcers in a Chinese tertiary care hospital. Int Wound J. 2019;16(6):1304–13. https://doi.org/10.1111/iwj.13190Chen T, Xiao S, Chen Z, Yang Y, Yang B, Liu N. Risk factors for peripheral artery disease and diabetic peripheral neuropathy among patients with type 2 diabetes. Diabetes Res Clin Pract. 2024;207:111079. https://doi.org/10.1016/j.diabres.2023.111079Chen T, Xiao S, Chen Z, Yang Y, Yang B, Liu N. Risk factors for peripheral artery disease and diabetic peripheral neuropathy among patients with type 2 diabetes. Diabetes Res Clin Pract. 2024;207:111079. https://doi.org/10.1016/j.diabres.2023.111079Doherty M, Jenkins W, Richardson H, Sarmanova A, Abhishek A, Ashton D, et al. Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: A randomised controlled trial. Lancet. 2018;392(10156):1403–12. https://doi.org/10.1016/S0140-6736(18)32158-5Doherty M, Jenkins W, Richardson H, Sarmanova A, Abhishek A, Ashton D, et al. Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: A randomised controlled trial. Lancet. 2018;392(10156):1403–12. https://doi.org/10.1016/S0140-6736(18)32158-5Алгоритмы специализированной медицинской помощи больным сахарным диабетом. Под редакцией И.И. Дедова, М.В. Шестаковой, О.Ю. Сухаревой.12-й выпуск. Сахарный диабет. 2025;26(2S):1–157. https://doi.org/10.14341/DM13042Algorithms of specialized medical care for diabetes mellitus patients. Edited by Dedov II, Shestakova MV, Sukhareva OYu. 12th edition. Sakharnyy diabet = Diabetes Mellitus. 2025;26(2S):1–157 (In Russ.). https://doi.org/10.14341/DM13042James R, Paul BJ. New and emerging therapies in gout. Rheumatol Autoimmun. 2023;3(2):70–77. https://doi.org/10.1002/rai2.12064James R, Paul BJ. New and emerging therapies in gout. Rheumatol Autoimmun. 2023;3(2):70–77. https://doi.org/10.1002/rai2.12064Fayazi HS, Yaseri M, Mortazavi SS, Sharifhassan Z, Assadinia AS. The relation between serum uric acid levels and diabetic peripheral neuropathy in type 2 diabetes in Guilan, North of Iran. BMC Endocr Disord. 2022;22(1):39. https://doi.org/10.1186/s12902-022-00952-5Fayazi HS, Yaseri M, Mortazavi SS, Sharifhassan Z, Assadinia AS. The relation between serum uric acid levels and diabetic peripheral neuropathy in type 2 diabetes in Guilan, North of Iran. BMC Endocr Disord. 2022;22(1):39. https://doi.org/10.1186/s12902-022-00952-5

The authors declare that there are no conflicts of interest present.