Contents
Download PDF
pdf Download XML
235 Views
97 Downloads
Share this article
Research Article | Volume 14 Issue: 3 (May-Jun, 2024) | Pages 1086 - 1090
A Study on serum uric acid levels in type 2 diabetes mellitus and its association with cardiovascular risk factors
 ,
 ,
1
Postgraduate
2
Professor & HOD
3
Assistant Professor Department of General Medicine, ACS Medical College and Hospital, Chennai.
Under a Creative Commons license
Open Access
PMID : 16359053
Received
April 9, 2024
Revised
April 30, 2024
Accepted
May 21, 2024
Published
June 18, 2024
Abstract

Background: The alarming prevalence of noncommunicable diseases, particularly diabetes mellitus and coronary heart disease, in India accounts for approximately 5.8 million deaths annually. Insulin resistance is a key factor in the development of diabetes mellitus and metabolic syndrome (MS), which is characterized by four components: hyperinsulinemia, hypertension, hyperlipidemia, and hyperglycemia. Each of these components is an independent risk factor for CHD and can collaborate to aggravate the progression of atherosclerosis and atheroscleropathy associated with MS and T2DM. Materials & Methods: This is hospital based cross sectional observational study which was conducted in the  Department of general medicine of Private medical college with study period of 1 year. The total sample size of the study was 100 patients. The collected data was entered in Microsoft Excel. Coding of the variables was done. Analysis was done using SPSS software (Version 27, IBM). Results: The subjects had an average age of 57.56 years and a mean BMI of 25.63, with a standard deviation of 3.90. Additionally, the WHR ranged from 0.79 to 1.55, indicating variations in body fat distribution and potential health risks. Fasting Blood Sugar (FBS) levels varied from 102 to 208 mg/dL, while Postprandial Blood Sugar (PPBS) levels ranged from 167 to 307 mg/dL, reflecting the variability in glucose metabolism. Serum uric acid levels ranged from 3.2 to 8.4 mg/dL, which is important for evaluating metabolic health and potential gout risk. Duration of DM is 4.5± 1.17. The prevalence of the condition was 43%, with a highly significant P value of 0.0001. Conclusion: Elevated serum uric acid levels was found to be prevalent in individuals with diabetes, with a significant positive correlation observed between serum uric acid and dyslipidemia, high triglycerides, hypertension, elevated BMI, and increased WHR. Additionally, it was observed that serum uric acid levels rose with the duration of diabetes.

Keywords
INTRODUCTION

The increase in the number of deaths from noncommunicable diseases, notably diabetes mellitus and coronary heart disease, is a significant problem in India, resulting in roughly 5.8 million fatalities per year1,2. Insulin resistance is a key factor in the development of diabetes mellitus and metabolic syndrome (MS). MS is made up of four main components, namely hyperinsulinemia, hypertension, hyperlipidemia, and hyperglycemia, each of which serves as an independent risk factor for CHD and can work together synergistically to accelerate the progression of both non-diabetic atherosclerosis and atheroscleropathy related to MS and T2DM.3,4.

Similarly, hyperuricemia, hyperhomocysteinemia, reactive oxygen species (ROS), and highly sensitive C-reactive protein (hsCRP) each play a crucial role in expanding the original Syndrome X described by Reaven in the atherosclerotic process5. Many previous studies have recommended regular screening of all type 2 diabetic subjects to identify individuals with a higher risk of subsequent atherosclerosis6. A strong association has also been demonstrated between uric acid levels and various other cardiovascular risk factors. Considering the scarcity of studies on this topic in India, an attempt has been made to examine the level of serum uric acid in type 2 diabetes mellitus and the correlation between elevated serum uric acid levels and cardiovascular risk factors such as obesity, hypertension, smoking, and dyslipidemia7,8. The present study is aimed to identify the level of serum uric acid levels in type 2 diabetes mellitus and its association with cardiovascular risk factors. The objectives of the study is to assess the uric acid status in patients with diabetes mellitus and to find its association with cardiovascular risk factors such as age, gender, BMI, waist-hip ratio, smoking, dyslipidemia with increased triglycerides, and hypertension.

MATERIAL AND METHODS:

This is hospital based cross sectional observational study which was conducted in the  Department of general medicine of Private medical college with study period of 1 year. The total sample size of the study was 100 patients. Inclusion criteria – 1) Patients with type 2 diabetes mellitus (irrespective of their glycemic status and duration of diabetes). 2) Patient’s age > 40 years. 3) Both sexes were included. Exclusion criteria – Patients with the following conditions were excluded from the study 1) Renal failure. 2) On long term diuretics and steroids. 3) Regularly consuming alcohol. 4) On antimetabolite and chemotherapy drugs. 5) Hepatic disorders.6) Peripheral vascular disease/ cerebrovascular disease/ pulmonary tuberculosis. 7) Renal transplant patients. 8) Pregnancy and lactating mothers. A written informed consent was obtained from all the patients. After informed written consent obtained, selected data will be elicited from the patients in structured proforma.

 

Data collection method: The data will be collected on Socio-demographic parameters like age, gender. Clinical parameters like Duration of diabetes, Family history of diabetes, Smoking history. Physical examination will be done to record anthropometric data like Body weight, height, BMI, WHR. Blood pressure will be recorded. Blood will be collected and sent to the laboratory for assessment of Fasting and postprandial blood sugar levels estimated by using glucosoxidase peroxidase (GOD/POD) method, Serum lipid profile and uric acid levels.

Estimation of serum uric acid will be done by using phosphotungstic acid method.

Step 1: De proteinisation: In a test tube to 1 ml of distilled water, 0.2 ml of serum, 0.4 ml of 2/3 N H2SO4, 0.4 ml sodium turgitate (10%) are added and sample centrifuged for 5 minutes.

Step 2: To 1 ml of the filtrate add 0.75N NaOH, saturated picric acid 0.5 ml mix well & wait for 15 minutes. Reading is taken at 490 nm calorimetrically.

Hyperuricemia has been arbitrarily defined as >7.0 mg/dL in men and >6. mg/dL in women.

The collected data was entered in Microsoft Excel. Coding of the variables was done. Analysis was done using SPSS software (Version 27, IBM). Descriptive statistics was used. Association between categorical tests. The outcomes of the treatment groups were compared using a test to reach the hypothesis, a P value less than 0.5 was considered significant.

RESULTS:

Of the 100 patients, (64%) were males and (46%) were females. (Chart 1)

Chart 1: Gender distribution among the study participants

 

 

Variables

Mean±SD

Age

57.56

BMI

25.63±4.90

WHR

0.79±1.67

FBS

102±208

PPBS

167±307

Serum uric acid

3.2±8.4

Duration of DM

4.5± 1.17

Table 1: Demographic details:

The average age is 58.56 years. The mean Body Mass Index (BMI) is 25.63, with a standard deviation of 3.90, indicating variations in body weight relative to height. The Waist-to-Hip Ratio (WHR) ranges from 0.78 to 1.55, which helps assess fat distribution and potential health risks. Fasting Blood Sugar (FBS) levels span from 101 to 208 mg/dL, while Postprandial Blood Sugar (PPBS) levels range from 165 to 307 mg/dL, indicating variability in glucose metabolism. Serum uric acid levels vary between 3.1 and 8.4 mg/dL, which is crucial for evaluating metabolic health and potential gout risk.

 

Table - 2: Association of risk factors with Cardiovascular Risk Factors.

Variables

Percentage

P value

Family History CAD

68%

0.001

Smoking among males

77%

0.003

Hypertension

Yes

49%

0.04

No

51%

 

Family history of coronary artery disease (CAD) is reported in 68% of the individuals, with a highly significant P value of 0.001, indicating a strong association. Smoking is prevalent among 77% of males, with a P value of 0.003, suggesting a significant link. Hypertension affects 49% of the population, with a P value of 0.04, indicating a noteworthy association.

 

Table 3: Association with Duration of Diabetes and Hyperuricemia

Variables

Percentage

P value

< 4 years

43%

0.0001*

>4 years

67%

 

For individuals with less than 4 years of the condition, the prevalence is 43%, with a highly significant P value of 0.0001. In contrast, those with more than 4 years of the condition account for 67%. This indicates a significant increase in the prevalence of the condition with longer duration.

 

Table 4: Association diabetes mellitus with hyperuricemia

Variables

Percentage

P value

Negative

85%

0.000

Positive

15%

 

The distribution and statistical significance of a certain variable within the studied population. A significant majority, 85%, tested negative for the variable, with a P value of 0.000, indicating a highly significant result. In contrast, only 15% tested positive. This stark contrast underscores the strong statistical difference between the negative and positive cases within the population.

DISCUSSION

In their analysis, Katsiki et al9. identified a robust association between elevated serum uric acid levels and diabetes and its related complications. In contrast, Keenan et al10 reported that increased serum urate levels were not associated with type 2 diabetes (T2DM), coronary heart disease (CHD), ischemic stroke, or heart failure (HF). Unlike most previously published studies on this topic, the aforementioned study by Keenan et al10 inferred the absence of a causal relationship between uric acid and cardiovascular complications in individuals with diabetes.

 

Variables

Mean±SD

Age

57.56

BMI

25.63±4.90

WHR

0.79±1.67

FBS

102±208

PPBS

167±307

Serum uric acid

3.2±8.4

Duration of DM

4.5± 1.17

 

 

 

 

 

 

 

 

 

The research performed by Choi H. K. et al11. investigated the relationship between gout and the likelihood of developing type 2 diabetes in men with a high cardiovascular risk profile. The study revealed that men with gout and a high cardiovascular risk profile have a greater chance of developing type 2 diabetes, regardless of other known risk factors. These findings imply reverse causality and raise further questions about the nature of the association between diabetes, serum uric acid, and diabetes-related complications, particularly coronary artery disease. Du L. et al12. also confirmed the increased risk of diabetes-related macrovascular complications, including CAD and cerebral infarction. After pooling estimates from 23 studies, the authors concluded that higher serum uric acid levels may contribute to cerebral infarction in patients with type 2 diabetes.

 

The association between the duration of diabetes and serum uric acid levels proved to be statistically significant, as indicated by a study conducted by Gagliardi A. C et al8, as well as research carried out by Javorsky et al13 and Kramer C. K. et al14. These findings also revealed a comparable relationship, with a notable impact of serum uric acid on future cardiovascular events.

 

The dissimilarity was substantive and validated through investigations conducted by Li, Q. et al15 and Li, L. X., et al16. Furthermore, though the research performed by Li, L. X., et al16. unveiled a correlative nexus between hypertension and hyperuricemia, it concurrently conveyed that this association may not necessarily culminate in an escalated risk of cardiovascular ailments, as posited by a multitude of alternative studies.

 

The research conducted underscores the robust association between serum uric acid and other risk factors, such as hyperlipidemia. Studies by Lehto et al.17, Nagahama et al18., and Zoppini et al19. have also demonstrated a strong connection between hyperuricemia and components of metabolic syndrome. In summary, although there is substantial evidence indicating that elevated serum uric acid concentrations are strongly associated with increased cardiovascular risk and poor outcomes, prospective population studies are often complicated by the presence of co-existing risk factors. In the current study, serum uric acid displayed a positive correlation with the duration of diabetes and cardiovascular risk factors such as obesity (as indicated by a high BMI and an abnormal waist-to-hip ratio), hypertension, and dyslipidemia, and the results were statistically significant.

CONCLUSION

Serum uric acid levels were significantly elevated in diabetic population. Significant positive correlation between serum uric acid Elevated levels of serum uric acid were observed in individuals with dyslipidemia and high triglycerides, as well as those with hypertension and elevated Body Mass Index (BMI) and Waist Hip Ratio (WHR). Furthermore, it was observed that serum uric acid levels increased with the duration of diabetes.

 

Acknowledgment: We are thankful to the entire study participants for their participation and full cooperation. We acknowledge the Department of General Medicine faculties for encouraging and supporting us.

Financial support and sponsorship: Nil

Conflicts of interest: Nil

REFERENCES
  1. Shrivastava U, Misra A, Mohan V, Unnikrishnan R, Bachani D. Obesity, Diabetes and Cardiovascular Diseases in India: Public Health Challenges. Current diabetes reviews, 2016.
  2. Kakkar R. Rising burden of Diabetes Public Health Challenges and way out. Nepal journal of epidemiology, 2016; 6(2): 557-9.
  3. Gupta R, Mohan I, Narula J. Trends in Coronary Heart Disease Epidemiology in India. Annals of global health, 2016; 82(2): 307-15.
  4. Tripathy JP, Thakur JS, Jeet G, Chawla S, Jain S, Pal A, et al. Burden and risk factors of dyslipidemia-results from a STEPS survey in Punjab India. Diabetes & metabolic syndrome, 2016.
  5. Bianchi C, Penno G, Malloggi L, Barontini R, Corfini M, Giovannitti MG, et al. Non-traditional markers of atherosclerosis potentiate the risk of coronary heart disease in patients with type 2 diabetes and metabolic syndrome. Nutrition, metabolism, and cardiovascular diseases: NMCD. 2008; 18(1): 31-8.
  6. Bonakdaran S, Kharaqani B. Association of serum uric acid and metabolic syndrome in type 2 diabetes. Current diabetes reviews, 2014; 10(2): 113-7.
  7. Chiou WK, Huang DH, Wang MH, Lee YJ, Lin JD. Significance and association of serum uric acid (UA) levels with components of metabolic syndrome (MS) in the elderly. Archives of gerontology and geriatrics, 2012; 55(3): 724-8.
  8. Gagliardi AC, Miname MH, Santos RD. Uric acid: A marker of increased cardiovascular risk. Atherosclerosis, 2009; 202(1): 11-7.
  9. Katsiki N, Papanas N, Fonseca VA, Maltezos E, Mikhailidis DP. Uric acid and diabetes: Is there a link? Current pharmaceutical design, 2013; 19(27): 4930-7
  10. Keenan T, Zhao W, Rasheed A, Ho WK, Malik R, Felix JF, et al. Causal Assessment of Serum Urate Levels in Cardiometabolic Diseases Through a Mendelian Randomization Study. Journal of the American College of Cardiology, 2016; 67(4): 407-16.
  11. Choi HK, De Vera MA, Krishnan E. Gout and the risk of type 2 diabetes among men with a high cardiovascular risk profile. Rheumatology (Oxford, England)., 2008; 47(10): 1567-70.
Recommended Articles
Research Article
Study of prevalence and Risk Factors of Non communicable Diseases among the Adult Population of Kokrajhar District, Assam
...
Published: 06/12/2024
Download PDF
Research Article
Clinico-Radiological Correlation of Degenerative Lumbar, Spine on Magnetic Resonance Imaging with Modified, Oswestry Disability Index
...
Published: 11/12/2024
Download PDF
Research Article
A Study of Electrocardiographic Abnormalities and Cardiac Markers in Patients with Acute Cerebrovascular Accidents in First 24 Hours
Published: 01/03/2022
Download PDF
Research Article
Primary Screening of Cervical Screening Tests in A Tertiary Care Centre.
...
Published: 11/12/2024
Download PDF
Chat on WhatsApp
Copyright © EJCM Publisher. All Rights Reserved.