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
