|Year : 2022 | Volume
| Issue : 4 | Page : 507-510
Uric acid level and its correlation with glycemic control in diabetics with normal renal function
Muzamil Latief1, Obeid Shafi2, Zhahid Hassan3, Summyia Farooq4, Farhat Abbas4
1 Division of Nephrology, GMC, Secunderabad, Hyderabad, Telangana, India
2 Flushing Hospital Medical Center, New York, USA
3 Department of Medicine GMC Baramula Kashmir, J and K Health Services, Kashmir, India
4 Division of Pathology, GMC, Srinagar, Jammu and Kashmir, India
|Date of Submission||22-Oct-2020|
|Date of Decision||10-May-2021|
|Date of Acceptance||28-May-2021|
|Date of Web Publication||28-Jan-2022|
Division of Pathology, GMC, Srinagar - 190 011, Jammu and Kashmir
Source of Support: None, Conflict of Interest: None
Introduction: Limited studies have evaluated the relationship between uric acid and diabetes mellitus (DM), with different studies reporting varying findings. We aimed to investigate the association between levels of uric acid and glycemic control in type 2 DM (T2DM) in our patient cohort. Materials and Methods: We analyzed 200 consecutive patients in the age group of 30–70 years suffering from T2DM with normal renal functions (glomerular filtration rate >60 ml/min/1.73 m2), after excluding patients taking medications for lowering uric acid levels or diuretics. Fasting blood glucose (FBG), random blood glucose (RBG), glycated hemoglobin (HbA1c), and serum uric acid levels were measured in all the patients. Results: The mean age of the study population was 55.25 ± 12.05 years. There was no statistically significant difference in mean age, FBG, RBG, serum uric acid, and HbA1c levels or between males and females in our study cohort. There was a statistically significant negative correlation (P < 0.05) between uric acid levels and HbA1c (r = −0.189) and FBG (r = −0.114). Conclusion: We report an inverse correlation between uric acid levels and glycemic control in diabetic patients with normal renal function, irrespective of gender.
Keywords: Diabetes mellitus, glycemic control, uric acid
|How to cite this article:|
Latief M, Shafi O, Hassan Z, Farooq S, Abbas F. Uric acid level and its correlation with glycemic control in diabetics with normal renal function. Med J DY Patil Vidyapeeth 2022;15:507-10
|How to cite this URL:|
Latief M, Shafi O, Hassan Z, Farooq S, Abbas F. Uric acid level and its correlation with glycemic control in diabetics with normal renal function. Med J DY Patil Vidyapeeth [serial online] 2022 [cited 2022 Jul 6];15:507-10. Available from: https://www.mjdrdypv.org/text.asp?2022/15/4/507/336826
| Introduction|| |
Diabetes mellitus (DM) is a progressive disease in which the risks of acute coronary syndrome, cerebrovascular accidents, microvascular events, and mortality are all strongly associated with hyperglycemia. Diabetic patients frequently are found to have elevated blood pressure, dyslipidemia, and renal impairment.,,
Approximately 10%–25% of the general population is reported to have hyperuricemia., Hyperuricemia has been associated with multiple diseases including gout, cardiovascular disease, kidney disease, hypertension, metabolic syndrome, obesity, dyslipidemia, and type 2 diabetes (T2DM).,,,,, However, independent causation has not been clearly delineated for these often-interlinked comorbidities. While hyperuricemia appears to increase the risk of T2DM, it is not clear if this relationship is independent of other metabolic factors.,,, It is not proven yet whether uric acid leads to insulin resistance or beta-cell secretory deficiency, or is it a byproduct of insulin resistance or hyperglycemia. This is an active area of research to address and answer how important is it to lower uric acid levels using drugs for better management of patients with diabetes. However, if uric acid is just a byproduct of impaired glucose metabolism, it may still be useful as an early marker of T2DM risk and guide to earlier interventions. There are suggestions that hyperuricemia is simply a byproduct of insulin resistance and glucose metabolism abnormality., Uric acid can work as a pro-oxidant, and thus, it may be a marker of oxidative stress. To answer some of these questions regarding uric acid levels and glycemic control, we undertook this observational study to evaluate the correlation between uric acid and glycemic status in T2DM.
| Materials and Methods|| |
This study was approved by the institute ethical committee (letter number 21/2016/AMB dated October 1, 2016). The observational study was conducted with patients between 30 and 70 years of age and a diagnosis of T2DM and estimated glomerular filtration rate above 60 ml/min/m2 eligible for inclusion. Patients who were on any antihyperuricemic drugs (such as allopurinol and febuxostat) or diuretics were excluded from the study. We included consecutive patients for the study, including both male and female genders, after obtaining written informed consent.
Blood samples were collected via venipuncture for all included patients after overnight fasting, and urine samples were collected from mid-stream morning urine. The following tests were performed in all patients: complete blood counts, fasting blood glucose (FBS), renal function test, glycated hemoglobin (HbA1c), serum uric acid levels, random blood glucose (RBS), and urine routine and microscopy. The biochemical parameters were measured using the semi-automated biochemistry analyzer (Humalyzer 3000, USA) in the clinical laboratory of our hospital as per the manufacturer's standard protocols. All the tests were performed by trained and certified laboratory technicians, with the precision of measurements maintained by regular calibration with the reference as per hospital policy.
Data were analyzed with SPSS statistical software version 19.0 (IBM Corporation; Armonk, NY, USA), applying descriptive statistics, t-tests, and Spearman correlation® analysis, with P < 0.05 being considered significant.
| Results|| |
The mean age of the study population was 55.25 ± 12.05 years. The mean age of the male and female patients was 55 ± 13.3 years and 55.5 ± 10.8 years, respectively. In the study, males constituted 54% (n = 108/200) and females constituted 46% (n = 92/200) of the patients.
The mean FBS of the male and female patients was 143.14 ± 15.67 mg/dl and 142.85 ± 13.70 mg/dl, respectively. The mean uric acid of the male and female patients was 4.02 ± 0.82 mg/dl and 3.95 ± 0.89 mg/dl, respectively. The mean HbAIc of the male and female patients was 8.3% ± 0.35% and 8.2% ± 0.45%, respectively. The difference in FBG, RBG, serum uric acid, and HbA1c levels or between males and females in our study cohort did not achieve statistical significance as demonstrated in [Table 1]. On applying tests for correlation, a statistically significant (P < 0.05) negative correlation was observed between uric acid levels and HbA1c levels (r = −0.189). Similarly, a statistically significant (P < 0.05) negative correlation was observed between uric acid levels and FBG levels (r = −0.114).
|Table 1: Gender-wise distribution of diabetic patients for various parameters|
Click here to view
| Discussion|| |
In the past, only a few studies have evaluated the relationship between uric acid and DM, and the observation has not been consistent. Some studies revealed that there is a positive relationship between serum uric acid levels and diabetes, while other studies showed no association, and few others showed an inverse association.,,,,,,,,,
In our study, the mean age of the patient's population was 55.25 ± 12.05 years. In a study by Dehghan A et al., the mean age of the patients was 52 years which is very close to our study observation. Fifty-four percent of the patients were males while the rest were females. The results were similar to the study by Bhole et al. and Bandaru and Shankar. In our study, we found that the inverse correlation between DM and increased serum uric acid levels was observed in both genders. We found uric acid level increasing with increasing FBG levels up to the level of 140 mg/dl but decreased when FBG levels are over 140 mg/dl. This observation is similar to a study by Nan et al. Herman et al., Tuomilehto et al., and Yano et al. have also reported that diabetic patients have low uric acid levels. In the study by Hodge et al., it was reported that uric acid was strongly related to 2-h postprandial glucose level in diabetic men and women (P < 0.001 for both genders). Our results showed that uric acid was inversely related with FBG (r = −0.114) and HbA1c (r = −0.189). These observations are supported by findings in the study by Bandaru and Shankar. In our study, the inverse correlation between elevated uric acid and HbA1c and FBG was observed even after adjusting age and gender.
In our study, serum uric acid level was negatively associated with diabetic control in both genders which is contrary to the study by Oda et al. in which they found that serum uric acid level was negatively associated with diabetes in men, not in women. However, in a study from Bangladesh by Haque et al., it was observed that there was a significant inverse association between the levels of uric acid and diabetes in adults which is similar to our findings.
A limitation of this study is that it was an observational study performed at a single center; hence, interpretation regarding implications for causality should be made with caution. However, our study adds to the body of evidence, suggesting the link between levels of uric acid and T2DM control.
| Conclusion|| |
Limited number of studies has evaluated the relationship between uric acid and diabetes, with results that have been inconsistent in the few studies that have looked at this association. Some studies revealed that there is a positive relationship between serum uric acid levels and diabetes, while other studies showed no association, and few others showed an inverse association. In our observational study, we report an inverse correlation between uric acid levels and glycemic control in diabetic patients with normal renal function, irrespective of gender.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al.
Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000;321:405-12.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2005;28 Suppl 1:S37-42.
Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycaemia. Geneva: WHO; 2006.
Centers for Disease Control and Prevention (CDC). Prevalence of overweight and obesity among adults with diagnosed diabetes--United States, 1988-1994 and 1999-2002. MMWR Morb Mortal Wkly Rep 2004;53:1066-8.
Dalbeth N, Merriman TR, Stamp LK. Gout. Lancet 2016;388:2039-52.
Haque T, Rahman S, Islam S, Molla NH, Ali N. Assessment of the relationship between serum uric acid and glucose levels in healthy, prediabetic and diabetic individuals. Diabetol Metab Syndr 2019;11:49.
Sanchez-Lozada LG, Rodriguez-Iturbe B, Kelley EE, Nakagawa T, Madero M, Feig DI, et al.
Uric acid and hypertension: An update with recommendations. Am J Hypertens 2020;33:583-94.
Ali N, Miah R, Hasan M, Barman Z, Mou AD, Hafsa JM, et al.
Association between serum uric acid and metabolic syndrome: A cross-sectional study in Bangladeshi adults. Sci Rep 2020;10:7841.
Ali N, Perveen R, Rahman S, Mahmood S, Rahman S, Islam S, et al.
Prevalence of hyperuricemia and the relationship between serum uric acid and obesity: A study on Bangladeshi adults. PLoS One 2018;13:e0206850.
Ali N, Rahman S, Islam S, Haque T, Molla NH, Sumon AH, et al.
The relationship between serum uric acid and lipid profile in Bangladeshi adults. BMC Cardiovasc Disord 2019;19:42.
Bhole V, Choi JW, Kim SW, de Vera M, Choi H. Serum uric acid levels and the risk of type 2 diabetes: A prospective study. Am J Med 2010;123:957-61.
Causevic A, Semiz S, Macic Dzankovic A, Cico B, Dujic T, Malenica M, et al.
Relevance of uric acid in progression of type 2 diabetes mellitus. Bosn J Basic Med Sci 2010;10:54-9.
Nan H, Pang Z, Wang S, Gao W, Zhang L, Ren J, et al.
Serum uric acid, plasma glucose and diabetes. Diab Vasc Dis Res 2010;7:40-6.
Cook DG, Shaper AG, Thelle DS, Whitehead TP. Serum uric acid, serum glucose and diabetes: Relationships in a population study. Postgrad Med J 1986;62:1001-6.
Kodama S, Saito K, Yachi Y, Asumi M, Sugawara A, Totsuka K, et al.
Association between serum uric acid and development of type 2 diabetes. Diabetes Care 2009;32:1737-42.
Tinahones FJ, Cardona F, Rojo-Martínez G, Almaraz MC, Cardona I, Vázquez-Mellado J, et al.
Decreased levels of uric acid after oral glucose challenge is associated with triacylglycerol levels and degree of insulin resistance. Br J Nutr 2008;99:44-8.
Becker BF. Towards the physiological function of uric acid. Free Radic Biol Med 1993;14:615-31.
Dehghan A, van Hoek M, Sijbrands EJ, Hofman A, Witteman JC. High serum uric acid as a novel risk factor for type 2 diabetes. Diabetes Care 2008;31:361-2.
Chien KL, Chen MF, Hsu HC, Chang WT, Su TC, Lee YT, et al.
Plasma uric acid and the risk of type 2 diabetes in a Chinese community. Clin Chem 2008;54:310-6.
Niskanen L, Laaksonen DE, Lindström J, Eriksson JG, Keinänen-Kiukaanniemi S, Ilanne-Parikka P, et al.
Serum uric acid as a harbinger of metabolic outcome in subjects with impaired glucose tolerance: The Finnish Diabetes Prevention Study. Diabetes Care 2006;29:709-11.
Kramer CK, von Mühlen D, Jassal SK, Barrett-Connor E. Serum uric acid levels improve prediction of incident type 2 diabetes in individuals with impaired fasting glucose: The Rancho Bernardo study. Diabetes Care 2009;32:1272-3.
Modan M, Halkin H, Karasik A, Lusky A. Elevated serum uric acid--A facet of hyperinsulinaemia. Diabetologia 1987;30:713-8.
Oda E, Kawai R, Sukumaran V, Watanabe K. Uric acid is positively associated with metabolic syndrome but negatively associated with diabetes in Japanese men. Intern Med 2009;48:1785-91.
Nan H, Dong Y, Gao W, Tuomilehto J, Qiao Q. Diabetes associated with a low serum uric acid level in a general Chinese population. Diabetes Res Clin Pract 2007;76:68-74.
Bandaru P, Shankar A. Association between serum uric acid levels and diabetes mellitus. Int J Endocrinol 2011;2011:604715.
Herman JB, Medalie JH, Goldbourt U. Diabetes, prediabetes and uricaemia. Diabetologia 1976;12:47-52.
Tuomilehto J, Zimmet P, Wolf E, Taylor R, Ram P, King H. Plasma uric acid level and its association with diabetes mellitus and some biologic parameters in a biracial population of Fiji. Am J Epidemiol 1988;127:321-36.
Yano K, Rhoads G, Kagan A. Epidemiology of serum uric acid among 8000 Japanese-American men in Hawaii. J Chronic Dis 1977;30:171-84.
Hodge AM, Boyko EJ, de Courten M, Zimmet PZ, Chitson P, Tuomilehto J, et al.
Leptin and other components of the metabolic syndrome in Mauritius--A factor analysis. Int J Obes Relat Metab Disord 2001;25:126-31.
[Table 1], [Table 1]