The Association Between Hyperuricrmia And Islet Function Indexes And The Incidence Of Chronic Complications In Type 2 Diabetes Mellitus

Part ?Objective To investigate the association between elevated serum uric acid levels and insulin resistance indexes and insulin secretion indexes in newly diagnosed type 2 diabetes mellitus(T2DM).Method A cross-sectional study was designed and performed,which enrolled a total of 403 newly diagnosed T2DM patients(mean age,50.21± 13.34 years[62.5%males]).Clinical characteristics and islet function indexes of all participants were analyzed based on gender-specific tertiles of serum UA levels.In addition,multiple linear regression analysis was conducted to investigate covariates associated with islet function indexes.Results The mean levels of serum UA were 331.05?mol/L[interquartile range(IQR):260.6,400.9 pmol/L]and 267.9?mol/L(IQR:204.7,331.9 ?mol/L)in men and women,respectively.The values of insulin secretion indexes involving AUCins30/glu30,AUCins120/glu120 and total insulin disposition index(DI120)in females were significantly higher than those in males.Apart from the HOMA-IR of men,serum UA was positively associated with insulin secretion and insulin resistance indexes both in men and women.Multivariable linear regression analysis showed serum UA exerted an independent impact on insulin secretion in females,but not on insulin resistance.And in males,islet function was simultaneously affected by serum UA age,BMI and serum lipids.Conclusions Serum UA harbored a positive correlation with insulin secretion and insulin resistance indexes in newly-diagnosed T2DM patients,which was influenced by gender,BMI,serum lipids.Hence,serum UA may be considered as a predictor for islet function in clinical practice.Part ?Objective To investigate the relationship between elevated serum uric acid levels and the incidence of choronic complications in patients with T2DM.Method A total of 1800 diagnosed patients with T2DM was selected to the cross-sectional study(mean age,56.4 ± 11.8 years[63.4%males]).The 1,800 subjects were divided into hyperuricemia group(HUA)and normal serum uric acid group(NUA),according to the diagnostic criteria of hyperuricemia for male and female.Clinical characteristics and the incidence of diabetic macroangiopathy,diabetic nephropathy,diabetic retinopathy,diabetic peripheral neuropathy,diabetic peripheral vascular disease and diabetic foot were compared between the two groups.In addition,correlation analysis was used to study the effect of uric acid on the complications,and logistic regression analysis was performed to explore the risk factors of the above-mentioned choronic complications in T2DM.Results The cross-sectional study showed that there were 231 patients in group HUA and 1569 patients in group NUA,with an average duration of 6.5 ±6 years.The levels of BMI,blood pressure and blood lipid in group HUA were higher than those in group NUA,while renal function indexes were significantly inferior to those in NUA group.Serum uric acid was positively correlated with sex,BMI,serum creatinine,triglyceride,smoking history and drinking history,but negatively correlated with fasting,postprandial blood glucose,glomerular clearance rate and serum HDL level.The incidence of diabetic macroangiopathy,diabetic nephropathy and diabetic peripheral neuropathy in HUA group was lower than that in NUA group.Logistic regression analysis showed that uric acid was an independent risk factor for diabetes mellitus complicated with macroangiopathy.Age,BMI,serum uric acid and hyperglycemia together affected the occurrence of chronic complications of type 2 diabetes mellitus.Conclusions In T2DM patients,serum uric acid is closely related to diabetic macrovascular,microvascular,peripheral nervous system complications.Therefore it has the value of predicting diabetic complications with chronic complications.Part ?Objective To research islet beta-cell function of the ageing population with T2DM,and find out protective factors and risk factors associated with it.Method We designed a cross-sectional analysis using 845 T2DM patients aged>60 years from 2012 to 2016(mean age,67.95 ± 6.3 years[51.8%males]).Clinical characteristics and islet function indexes of all participants were analyzed based on gender-specific groups.In addition,multiple linear regression analysis was conducted to investigate covariates associated with islet function indexes.Results There were no difference between men and women in glycemic control,including fasting and postprandial blood glucose.Men had lower value on HOMA-IR,AUCins30/glu30,AUCins120/glu120 and DI120(P=0.045)compared with women with diabetes.The difference of HOMA-? and DI30 were not significant.Multivariable linear regression analysis showed the islet function in the elderly was associated with age,uric acid,BMI,duration,HbAlc,serum lipid and smoking history.Among the above-mentioned factors,high HbAlc,long duration and smoking history decrease insulin secretion,high BMI and uric acid had stimulated effect on?-cell but aggravated insulin resistance.High density lipoprotein cholesterol(HDL-c)was a protective factor.Conclusions In the aging population with T2DM,decreased insulin secretion in females preceded males,and insulin sensitivity of males was better than females.Among related factors,BMI,duration of T2DM,and HbAlc play important roles in islet function.