ASSOCIATION OF SERUM URIC ACID WITH DIABETES MELLITUS TYPE 2: A CROSS SECTIONAL STUDY IN KARACHI, PAKISTAN

Abstract

Type 2 Diabetes mellitus (T2-DM) is a highly prevalent metabolic disease which is characterized by insulin resistance or lack of insulin production. Hyperuricemia (HUA) is associated with Diabetes mellitus (DM). Worldwide, DM is the fifth leading cause of mortality and results in 4 million deaths annually, with T2-DM being the predominant type. It results in several macrovascular and microvascular complications leading to increased morbidity and mortality. DM affects 26.3 % (19.4 million) of the national population in Pakistan. Therefore there is a need to identify prognostic and predictive biomarkers which could be estimated for early detection of diabetic complications. Elevated serum uric acid (SUA) levels result in grave health implications and utilization of enormous health resources in diabetic patients. Both DM and HUA are considered to be metabolic disorders. The prevalence of HUA according to different national studies conducted in Pakistan is 30.1% and 39%. The metabolic disorders of DM and HUA are strongly associated with each other. The objective of this study was to determine the association between SUA levels and T2-DM. This was a cross-sectional study with a sample size of 85 patients which was conducted in National Medical Center (NMC) in collaboration with Bahria University Health Sciences Campus Karachi (BUHSCK), Pakistan. Known cases or diagnosed patients of T2-DM on oral hypoglycaemic agents (obese and non-obese) were included while DM Type 1 and other coexisting diseases such as pancreatitis and other endocrine disorders (Acromegaly, Pheochromocytoma and Thyrotoxicosis) were excluded. Blood specimens were collected through venipuncture technique and SUA levels were analyzed using Chemistry Analyzer technique. Other laboratory parameters which were analyzed were glycated hemoglobin (HbA1C), Fasting Blood Sugar (FBS) and Lipid Profile. Weight, height and Body Mass Index (BMI), waist circumference, waist hip ratio and waist height ratio were also recorded. The Pearson correlation analysis which is suggestive of a linear relationship between uric acid and other variables revealed a positive correlation with age, waist circumference, waist to hip ratio, systolic blood pressure (SBP), FBS and Triglycerides (TG). However it revealed a slightly negative correlation with BMI, hip circumference, diastolic blood pressure (DBP), HbA1C, LDL, and HDL. The results of univariate viii analysis with uric acid revealed a positive association of abnormal uric acid with increasing age, male gender, LDL and HDL. There was a negative association with BMI, DBP and FBS. No association was found with SBP, TG and HbA1C. In multivariate analysis which explains the relationship between several variables, it was observed that abnormal uric acid revealed a positive association with age, SBP and LDL. However, there was a negative association with male gender, BMI, DBP, FBS, HbA1C, TG, and HDL. The results of this study revealed that the frequency of hyperuricemia (HUA) was found to be 9.4% and predominantly in elderly male patients. HUA was not associated with T2-DM. However it could possibly serve as a screening marker for complications in T2-DM patients, particularly elderly diabetic patients of male gender and with moderately controlled glycemic index. The Uric acid HDL Ratio (UHR) and Waist Height Ratio was also found to be negatively associated with FBS and HbA1C and therefore glycemic control. However, waist hip ratio was found to be significantly associated with glycemic index