Clinical Study Of Serum Uric Acid Level And Carotid Intima-media Thickness In Patients With Type 2 Diabetes Mellitus

ObjectiveTo investigate the correlation between serum uric acid level and carotid intima-media thickness in patients with type 2 diabetes mellitus,and to explore the cut-off point of serum uric acid control in patients with type 2 diabetes mellitus complicated with hyperuricemia,so as to provide clinical theoretical basis for the prevention of diabetic cardiovascular disease.MethodsA total of 4177 patients were selected from the Standardized Metabolic Disease Management Center(MMC)of the First People’s Hospital of Yunnan Province from June 2018 to December2020,and 1800 patients who met the criteria and had complete data were screened.The course of disease,age,gender,smoking history,drinking history,and whether to take antihypertensive drugs,lipid-lowering drugs,and uric acid-lowering drugs were recorded.Height(cm),weight(kg),hip circumference(HC)and waist circumference(WC)were measured and body mass index(BMI)was calculated.Serum uric acid(SUA),total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-c),low density lipoprotein cholesterol(LDL-c),fasting blood glucose(FBG),2-hour postprandial blood glucose(2h PG),fasting plasma insulin(FINS),2-hour postprandial plasma insulin(2 h INS),fasting C-peptide(FCP),2-hour postprandial C-peptide(2h CP),glycated hemoglobin A1c(Hb A1c),serum creatinine(SCr),blood urea nitrogen(BUN).Visceral fat area(VFA),subcutaneous fat area(SFA)and bilateral carotid intima-media thickness(c IMT)were measured.The diagnostic criteria of HUA were in accordance with the 2019 Chinese Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout.According to the Cardiology Journal’s January 2021 expert consensus on the diagnosis and management of Patients with hyperuricemia and High Cardiovascular Risk,The serum uric acid was divided into group A(SUA < 300μmol/L),group B(300μmol/L≤SUA≤420μmol/L)and group C(SUA > 420μmol/L).The relationship between serum uric acid level and carotid intima-media thickness in T2 DM patients was analyzed by comparison among the three groups.ResultsThe mean age of the patients in this study was 53.52±10.29 years,and the prevalence of abnormal c IMT was 644/1800(36%).SUA < 300μmol/L,300μmol/L≤SUA≤420μmol/L,SUA >420μmol/L in the three groups of gender,waist circumference,hip circumference,VFA,SFA,BMI,FBG,2h PG,2h INS,Hb A1 c,TG,TC,HDL-c,ALT,AST,ALB,There were significant differences in BUN,Cr,FCP,2h CP and bilateral c IMT distribution(P < 0.05).Multiple linear regression analysis showed that waist circumference,SFA,TG,ALT,ALB and Cr were independent influencing factors of SUA(P < 0.01).Pearson analysis with bilateral c IMT as the dependent variable showed that SUA was positively correlated with bilateral c IMT.There were significant differences in age,gender,smoking,waist circumference,hip circumference,SFA,FCP,2h CP,LDL-c,BUN,Cr,SUA and whether taking antihypertensive and lipidlowering drugs between the normal c IMT group and the abnormal CIMT group(P < 0.01).Binary logistic analysis showed that gender,age,smoking,SFA,2h CP,LDL-c and SUA were independent risk factors for c IMT.The ROC curve showed that the optimal SUA control cut-off point was 345μmol/L in men and350.5μmol/L in women,which was the best cut-off point to prevent T2 DM from developing atherosclerosis.Conclusion(1)This study was based on T2 DM patients.Wc,HC,VFA,SFA,BMI,TG,TC,HDL-c,ALB,AST,BUN,Cr,MS and bilateral c IMT were higher in T2 DM patients with HUA than those without HUA.There is a significant correlation between serum uric acid and bilateral carotid intima-media thickness.Serum uric acid is an independent risk factor for abnormal carotid intima-media thickness.It is concluded that T2 DM patients with HUA are prone to harm multiple organs of the whole body,and it is an independent risk factor for atherosclerosis.Therefore,we should closely monitor the serum uric acid level of T2 DM patients and actively control HUA,and find the best control target of SUA.A clinical study of 1800 patients with type 2 diabetes mellitus(T2DM)and hyperuricemia(HUA)showed that serum uric acid should be controlled ≤350μmol/L.(2)SUA in T2 DM patients can aggravate carotid intima-media thickness and promote the occurrence and development of atherosclerosis.At present,the medical workers in China have insufficient understanding of T2 DM combined with HUA,and the treatment rate and compliance rate of SUA are low.This study observed that the treatment rate of T2 DM patients with HUA is only 9.6%,leaving cardiovascular risk.Therefore,it is reminded that medical workers should carry out timely intervention to delay the occurrence of chronic complications and reduce cardiovascular mortality of patients.