Hyperuricemia Linked to Diabetes Development in Young Adults

Dr. Eswar Krishnan said at the annual meeting of the American College of Rheumatology, "Hyperuricemia may be a useful marker for predicting Type 2 diabetes among young adults."

But Dr. Krishnan also cautioned that it is not known whether high serum levels of uric acid play a causal role for developing Type 2 diabetes, nor is it known if an intervention can prevent diabetes from developing.

This finding follows a meeting report from Dr. Krishnan earlier this year that hyperuricemia in young adults also linked with a significantly increased risk for the development of coronary atherosclerosis, a finding made using the same database.

Both analyses used data collected from 5,115 asymptomatic men and women, aged 18-30, in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants enrolled in four U.S. cities. Half were African American, half were white, their mean age was 25, and none had long-standing risk factors for coronary disease. At baseline their average body mass index was 22 kg/m², and they reported on average a moderate amount of regular physical activity. The new diabetes analysis used data collected during 13 years of follow-up from 4,762 of the subjects.

The cumulative incidence of newly diagnosed Type 2 diabetes during follow-up ranged from 5% among people with baseline uric acid levels of less than 7.0 mg/dL to 17% among those with a baseline level of 9.0 mg/dL or higher. Type 2 diabetes was diagnosed in participants who had a fasting plasma glucose level of at least 126 mg/dL.

In a multivariate analysis that controlled for several baseline variables including age, gender, ethnicity, family history of diabetes, body mass index, physical activity, and blood glucose level, people with a baseline serum uric acid level of 7.0 mg/dL or greater had a statistically significant, 94% higher risk for developing Type 2 diabetes during follow-up, compared with people with a baseline level of less than 5.0 mg/dL, said Dr. Krishnan, a rheumatologist at Stanford (California) University.

Only ten of the more than 4,000 people in the analysis had clinical features at baseline that met the diagnostic criteria for metabolic syndrome. When these 10 were excluded, the relationship between hyperuricemia and development of diabetes remained about the same, with a 99% increased risk for incident diabetes in those with a baseline serum uric acid of 7.0 mg/dL or higher compared with those with a level of less than 5.0 mg/dL.

Dr. Krishnan disclosed receiving research support and serving as a consultant to Takeda, a company that markets febuxostat (Adenuric), a drug that lowers uric acid levels. Some of his associates on this study are employees of Takeda. Dr. Krishnan also formerly held stock in Savient, a company that is developing another uric acid lowering drug. Presented at the annual meeting of the American College of Rheumatology, Nov 2009