An elevated serum uric acid level increases the likelihood of developing type 2 diabetes in individuals with impaired glucose tolerance at baseline, according to a report in the March issue of Diabetes Care. Dr. Leo Niskanen from Kuopio University Hospital, Kuopio, Finland stated that, "There has been a long debate, whether elevated uric acid is harmful per se or just an innocent bystander." While uric acid correlates with components of the metabolic syndrome, it is "an endogenous antioxidant and, therefore, uric acid is a double-edged sword," he noted.
Dr. Niskanen and colleagues examined the role of uric acid in predicting changes in glucose tolerance and insulin levels and in the development of type 2 diabetes in 475 patients in the Finnish Diabetes Prevention Study.
Increasing uric acid concentrations were associated with increasing body mass index, plasma glucose and insulin concentrations, the authors report.
Baseline uric acid levels were associated with changes in insulin levels during follow-up, the results indicate, even after adjustment for age, sex, blood pressure medication, and other factors. Similarly, baseline uric acid levels were associated with increases in fasting and 2-hour plasma glucose concentrations during follow-up, the researchers note, but this association disappeared after adjusting for baseline body mass index and its changes.
Individuals whose uric acid level changes were in the upper third were nearly twice as likely to develop diabetes during follow-up as individuals with less significant uric acid level changes, the investigators found.
Baseline uric acid levels predicted diabetes even after adjustment for variables noted above, the investigators say, but changes in uric acid levels were not associated with incident diabetes after adjustment for these variables.
"Do not ignore high uric acid levels," Dr. Niskanen advised. "It is a warning sign. So far it is only a marker and probably more so in pre-diabetes. With overt diabetes and hyperglycemia, uric acid levels decline."
Also, "Uric acid is a widely available, inexpensive marker, although commonly overlooked except in gouty diathesis," Dr. Niskanen concluded. "The presence of hyperuricemia helps to identify subjects at risk for adverse health outcomes."
Diabetes Care 2006;29:709-711.
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