Zhongguo quanke yixue (May 2023)
Association between Serum Uric Acid and the Risk of Type 2 Diabetes Mellitus: a Population-based Prospective Cohort Study
Abstract
Background Hyperuricemia (HUA) caused by elevated serum uric acid (SUA) has become the fourth most common disease after hyperglycemia, hyperlipidemia, and hypertension, and the second most common metabolic disease after diabetes. It has been shown that elevated SUA levels are significantly associated with the risk of type 2 diabetes mellitus (T2DM). However, there is a lack of studies on Chinese population and studies on HUA combined with unhealthy lifestyle or chronic disease. Objective To investigate the association between baseline SUA levels, HUA combined with unhealthy lifestyle or chronic diseases and the risk of T2DM in health examination population. Methods A total of 17 626 individuals meeting the inclusion and exclusion criteria who had underwent at least two physical examinations from 2017 to 2020 in Preventive Treatment & Health Management Center, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine were selected as the subjects. Information about their demographics, lifestyle, physical examination results, and laboratory indicators was collected. A follow-up was carried out with them until the onset of T2DM or the end of follow-up (2020-12-31), during which the onset day of T2DM and clinical visit information for T2DM were collected. The cumulative incidence and incidence density of T2DM in the total population, and cumulative incidence of T2DM in subgroups were calculated. The Cox proportional-hazards model was used to investigate the association between baseline SUA level and the risk of T2DM. And stratified multivariate Cox proportional-hazards regression model was used to further analyze their association in different subgroups. Results The subjects had a median age of 38.2 (31.9, 49.6) years, a median baseline SUA level of 304.50 (248.00, 374.00) μmol/L, and an overall prevalence of HUA of 13.12%. The cumulative follow-up was 54 633 person-years, with a median follow-up of 3.10 years. There were 479 new cases of T2DM. The incidence density was 8.77 〔95%CI (8.00, 9.59) 〕 /1 000 person-years and the cumulative incidence rate was 2.72%〔95%CI (2.48%, 2.97%) 〕. Higher cumulative incidence rate of T2DM was found in older age group (≥60 years old), male cases, or those with current smoking, current alcohol drinking, BMI≥28.0 kg/m2, hypertension, dyslipidemia, or HUA. The multivariate-adjusted Cox proportional hazards regression model showed that HUA patients had an increased risk of T2DM, with an HR of 1.32〔95%CI (1.04, 1.67), P=0.023〕. For every 10 μmol/L increase in baseline SUA level, the risk of T2DM increased by 3%〔HR=1.03, 95%CI (1.01, 1.04), P<0.001〕. Stratified analysis of multivariate Cox proportional hazards regression model showed that the risk of T2DM increased in 60-year-olds and above〔HR=6.78, 95%CI (4.16, 11.03), P<0.001〕, females 〔HR=2.31, 95%CI (1.54, 3.45), P<0.001〕, current smokers 〔HR=1.79, 95%CI (1.23, 2.60), P=0.002〕, current alcohol drinkers 〔HR=1.61, 95%CI (1.23, 2.10), P<0.001〕, individuals with BMI≥28.0 kg/m2〔HR=1.69, 95%CI (1.07, 2.68), P=0.026〕, hypertensioners 〔HR=2.89, 95%CI (2.15, 3.89), P<0.001〕, or individuals with dyslipidemia 〔HR=2.39, 95%CI (1.80, 3.16), P<0.001〕with HUA. Conclusion Elevated baseline SUA levels are associated with a high risk of T2DM in health examination population, and the risk may be even higher in elderly people, females, current smokers, current drinkers, individuals with obesity, hypertension, or dyslipidemia with HUA.
Keywords
