Hypouricemia and hyperuricemia in type 2 diabetes: two different phenotypes

Abstract

Background and Design Conflicting data exist about uric acid levels in type 2 diabetes mellitus, as low levels were found in diabetic patients, while elevated serum uric acid is a feature of hyperinsulinemia and impaired glucose tolerance. The present study was addressed to evaluate the relation between uric acid and metabolic parameters, creatinine clearance and albumin excretion rate in a cohort of type 2 diabetic patients. Results Hyperuricemic patients were older and had higher values of body mass index (BMI), systolic and diastolic blood pressure, triglycerides, albumin excretion rate, C‐peptide and prevalence of hypertension, metabolic syndrome and macroalbuminuria and lower values of high‐density lipoprotein (HDL)‐cholesterol, creatinine clearance and glycated haemoglobin (HbA 1c). The correlations between uric acid levels and triglycerides, BMI, systolic blood pressure, albumin excretion rate, C‐peptide, creatinine clearance, HDL‐cholesterol and HbA 1c remained significant in a multiple regression analysis after adjustment for age, sex and duration of diabetes. After performing multiple logistic regression analyses, uric acid levels were independently associated with hypertension [odds ratio (OR) = 1·8; 95% confidence interval (CI) 1·6–2], after adjustment for age, sex, duration of diabetes and macroalbuminuria (OR = 1·5; 95% CI 1·1–2·0), after adjustment for age, sex, HbA 1c levels, creatinine clearance, duration of diabetes and blood pressure levels and the metabolic syndrome (OR = 1·6; 95% CI 1·5–1·8), after adjustment for age, sex and creatinine clearance. Conclusions In type 2 diabetes, hyperuricemia seems to be associated with the insulin‐resistant syndrome and with early onset or increased progression to overt nephropathy, while hypouricemia is associated with worse metabolic control, hyperfiltration and a late onset or decreased progression to overt nephropathy.