In patients with type 2 diabetes mellitus (T2DM), the risk of incident gout is markedly decreased among those with poorly controlled blood glucose levels (as indicated by an increased A1C level), according to the results of an observational study using the UK-based Clinical Practice Research Datalink. From the base population of patients in UK general practices with T2DM, 7,536 cases of incident gout were matched with the same number of gout-free controls. Those with an A1C level <7% were at greater risk of gout than those with an A1C level of 7.0–7.9 (OR 0.79, 95% CI 0.72–0.86), 8.0–8.9 (OR 0.63, 95% CI 0.55–0.72) or ≥9% (OR 0.46, 95% CI 0.40–0.53). The risk of gout was also found to decrease in association with increasing duration of T2DM.