| BackgroundDiabetes Mellitus is a common chronic non-communicable disease due to the pancreas does not produce enough insulin or the body cannot effectively use the insulin.Rapidly social and economic development is leading the transition from traditional dietary pattern to the rapid nutrition characterized by the eating habits of refined rice and a sedentary lifestyle,which making the problems of over-nutrition and under-nutrition at the same time,directly leading to the significant increase in the prevalence of diabetes in China.In 2015,nearly 100 million diabetes patients in China causing the direct economic burden of about 219.95 billion per year,the population of diabetes reached to 114 million in 2017,is expected to increase by 2045 to more than 150 million people.China has the largest number of diabetes patients,as the number of diabetic’s increases and an increased risk of disability,the national economic loss and per capita economic burden caused by China are rising day by day.Since type 2 diabetes is characterized by insulin resistance,patients diagnosed with diabetes often accompany with abnormal metabolism,so metabolic diseases such as hypertension,increased triglycerides and decreased HDL-C are considered as risk factors for diabetes.High uric acid is closely related to insulin resistance,it may be an independent predictor of cardiovascular disease,previous studies have demonstrated that uric acid degradation is purine nucleoside and glycogen final oxidation product of glycolysis,uric acid can protect the extracellular environment from oxidative damage induced by free radicals,it also can induce oxidative stress reaction in vascular smooth muscle cells,fat cells and islet cell.Due to the lack of uricase in humans,uric acid can easily accumulate in the body,and the elevation of uric acid level has become an important part of metabolic syndrome.We still don’t know the specific role uric acid played in blood glucose metabolism.Faced with these inconsistent results of these studies,our study intends to explore the relationship between blood glucose and uric acid,identify the influence of uric acid on blood glucose level,and provide an important theoretical basis for whether the medical reference range of serum uric acid should be reformulated as well as the prevention and control of diabetes.Objectives1.To identify risk factors affecting blood glucose levels.2.To explore whether there is a correlation between serum uric acid and blood glucose.For nonlinear correlation,clarify the curve shape and identify possible threshold points.For linear correlation,determine the magnitude and direction of the influence of uric acid on blood glucose.3.To evaluate interaction effect between inflammation/hypertension/dyslipidemia and uric acid on diabetes.MethodsData was collected from the China Health and Retirement Longitudinal Study.In 2011 and 2015,11,847 and 5,433 subjects who received blood samples were included in the two rounds of surveys respectively,totaling 14,378 subjects.Univariate regression and stepwise regression were introduced to screen out confounders which may affect the association between uric acid and blood glucose,and further established a multivariate regression statistical model.Restrictive cubic splines were used to determine whether there was a non-linear correlation,curve shape and threshold point between serum uric acid and blood glucose level.Piecewise linear regression or multiple linear regression were used to explore the influence degree of uric acid on blood glucose.Further explore the influence of gender and diabetes on the relationship between serum uric acid and blood glucose.Finally,Logistic regression was used to calculate the interaction between inflammation/hypertension/dyslipidemia and uric acid on blood glucose.Main results1.Age,education level,smoking,alcohol consumption,hypertension,dyslipidemia,Body Mass Index,plasma urea nitrogen,plasma protein,High sensitivity C-reactive protein and estimated glomerular filtration rate were confirmed the possible confounders affecting blood glucose levels through multivariate regression analysis.2.In the general population,there was a U-shaped curve between serum uric acid and fasting blood glucose(β2=2.88,P<0.01),and no association with HbA1c levels.3.Stratified by gender,non-linear correlation between uric acid and blood glucose in male was not significant.U-shaped association between serum uric acid and fasting blood glucose and HbAlc levels were found in female group(β2=5.18,P<0.01;β2=0.11,P<0.01).4.According to the classification of diabetes,approximate L-type association between serum uric acid and fasting blood glucose was found only in patients with diabetes(β2=11.01,P<0.01).Further stratified by gender,L-type association between serum uric acid and fasting blood glucose(β2=16.81,P<0.01)only existed in diabetes women.5.The additive interaction analysis showed that there was no statistical significance between inflammation/hypertension/dyslipidemia and serum uric acid after adjusting for all potential covariates.ConclusionsThe present study demonstrated a U-shaped curve between uric acid and fasting blood glucose in the study group,but not in HbA1c.The differences between genders and with-or without-diabetes,suggesting that gender and blood glucose should be fully considered when formulating uric acid reference range.Also,this is a cross-sectional study,further longitudinal studies or clinical trials are needed to demonstrate the results. |
PDF Full Text Request