DREAM Team Updates March 2026

DREAM Team Newsletter

March 2026 | Issue 8.2

HEALTH SPOTLIGHT: GOUT AND DIABETES

By Sebastian Wahab, PharmD Candidate, 2026

Six percent of the population has diabetes. 20% of patients with diabetes have gout. Gout can lead to the formation of urate crystal deposits known as tophi, as well as painful joint flares. Left untreated, tophi in the feet can ulcerate, potentially delaying ulcer healing and increasing the risk of foot infections and amputations. The gold standard for diagnosis of gout is the detection of urate crystals by microscopy of joint fluid or tophaceous material.1

Serum urate levels less than 6mg/dL are the goal per the American College of Rheumatology guidelines (in patients with and without diabetes) to lower joint and cardiovascular risk.2 Urate-lowering therapies (ULT) are used to achieve this goal and prevent future flares and urate depositions. Initiating ULT is strongly recommended for gout patients with one or more subcutaneous tophi, or evidence of radiographic damage attributable to gout, or two or more gout flares per year.3 Discontinuation of recommended ULT is known to result in frequent recurrence of gout flares and urate depositions. Adherence to the gout treatment regimen is a problem, ranking lowest among treatments for seven common chronic medical conditions.4

Allopurinol is the preferred first-line ULT for people with moderate to severe chronic kidney disease. It is recommended to start at a low dose of allopurinol and increase the dose to achieve a serum urate level of <6 mg/dL. ULT can be initiated during a gout flare or when the flare subsides. An active flare can be treated with colchicine, NSAIDs, or a steroid medication.3

Medication is not a replacement for a healthy lifestyle. Non-pharmacotherapy recommendations for gout include weight loss as well as limiting high corn fructose syrup, alcohol, and purine intake, such as sardines, beer, or organ meat (kidneys, liver).3 This essay is a reminder for us to note the importance of non-pharmacotherapy and adherence to maintenance medications, even if one is not currently experiencing a gout flare.

References:

Claus Rasmussen, Jesper Walther Larsen, Peter C.W. Holm, Gunnar L. Nielsen; Gout: An Overlooked Disease in Patients With Diabetes? A Danish Prospective Cohort Study With 2 Years of Follow-Up. Clin Diabetes 18 April 2025; 43 (2): 282–290.
Borghi C, Piani F. Uric Acid and Risk of Cardiovascular Disease: A Question of Start and Finish. Hypertension. 2021 Nov;78(5):1219-1221. doi: 10.1161/HYPERTENSIONAHA.121.17631. Epub 2021 Oct 13. PMID: 34644173.
FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res (Hoboken). 2020;72(6):744-760. doi:10.1002/acr.24180
Briesacher BA, Andrade SE, Fouayzi H, Chan KA. Comparison of drug adherence rates among patients with seven different medical conditions. Pharmacotherapy. 2008;28(4):437-443. doi:10.1592/phco.28.4.437.

TO GOOD HEALTH

Anne Lee, RD, CDCES

Black Bean Salad

Keeping some cans of low-sodium beans, corn, tomatoes and some strong-flavored herbs on hand can make fast-dinner preparation much easier than you think. This recipe can make a quick meal on a busy night. The green onions, lime juice and spices add much flavor to this simple salad.

15 oz Black Beans canned, rinsed, drained.
15 oz Corn canned and drained or 2 cups corn fresh or frozen, thawed.
4 stalks Green Onions chopped
1 Green Bell Pepper chopped
2 Tomatoes seeded, chopped
1 Jalapeño Pepper seeded, minced, optional
1 Avocado peeled, pitted, diced, optional
1 Lime juiced
1/4 teaspoon Garlic Powder
1/2 teaspoon Chili Powder
1/2 teaspoon Ground Cumin
2 tablespoons Olive Oil

Combined ingredients in a large bowl. Chill for an hour, if possible, before serving.

Makes 6 servings.

This recipe does not adhere to Kosher guidelines

Source: https://eatfresh.org/recipe/salads/black-bean-salad/

TUC DIABETES FELLOWSHIP PROGRAM

GRANTED FULL ACREDITATION BY THE AMERICAN COLLEGE OF DIABETOLOGY

TUC's Diabetology Fellowship is a comprehensive one-year program offering intensive education around all types of diabetes and its complications. Led by Sumera Ahmed, MD, Professor and Diabetologist, this program trains primary care physicians to serve as diabetes clinical care experts.

We are delighted to announce that the program has been granted a 3-year full accreditation by the American College of Diabetology.

DREAM TEAM - NEW MEMBERS

VERONICA ALCARAZ-REYES

COMMUNITY HEALTH WORKER

Veronica is a Community Health Worker (CHW) joining us part time. Born and raised in Sonoma, CA, she comes ready to support our outreach to the Spanish-speaking community and to boost our referrals system to community resources for diabetes, hypertension, and hyperlipidemia. Veronica received her Medical Assistant certificate in 2020 and has worked as one for the past five years. She obtained her CHW certificate from the Northern California Center for Well Being last year in April 2025. She keeps busy, effectively juggling multiple jobs and a growing family. Veronica enjoys the outdoors and loves going to the park with her kid and hiking on her days off.

MOBEC

THE MOBILE DIABETES EDUCATION CENTER

MOBEC offers FREE diabetes and cardiovascular screening and education to the people of Napa and Solano Counties. We partner with a variety of community-based organizations such as community centers, faith-based organizations, low-income and senior housing complexes to bring our services to the community.

Services include:

Prediabetes and diabetes risk test.
Blood glucose and A1C.
Blood pressure.
Depression, cholesterol, and type 1 diabetes screenings - when available.
Personalized education on diabetes prevention and management.
Resources for tobacco cessation, food distribution, transportation, and other community services as needed.

MOBEC will be visiting Napa, Dixon, Fairfield, Vallejo, and Suisun in the next few weeks. Scan the QR code or follow the link to visit our calendar of events in the MOBEC webpage and learn where and when we will be near you!

Newsletter Credits

Editor: Jay Shubrook, DO

Designer: Maryelli Ray