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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

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Front. Med.    2020, Vol. 14 Issue (6) : 802-810    https://doi.org/10.1007/s11684-019-0723-7
RESEARCH ARTICLE
Serum uric acid and risk of incident diabetes in middle-aged and elderly Chinese adults: prospective cohort study
Di Cheng1, Chunyan Hu1, Rui Du1, Hongyan Qi1, Lin Lin1,2, Xueyan Wu1, Lina Ma1, Kui Peng1, Mian Li1, Min Xu1, Yu Xu1, Yufang Bi1, Weiqing Wang1, Yuhong Chen2(), Jieli Lu1()
1. Department of Endocrine and Metabolic Diseases, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
2. Department of Endocrine and Metabolic Diseases, Ruijin Hospital North, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 201821, China
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Abstract

The association between serum uric acid and the risk of incident diabetes in Chinese adults remains unknown. This study aimed to investigate this association in a community-dwelling population aged≥40 years in Shanghai, China. Oral glucose tole3rance test was conducted during baseline and follow-up visits. Relative risk regression was utilized to examine the associations between baseline gender-specific serum uric acid levels and incident diabetes risk. A total of 613 (10.3%) incident diabetes cases were identified during the follow-up visit after 4.5 years. Fasting plasma glucose, postload glucose, and glycated hemoglobin A1c during the follow-up visit progressively increased across the sex-specific quartiles of serum uric acid (all Ps<0.05). The incidence rate of diabetes increased across the quartiles of serum uric acid (7.43%, 8.77%, 11.47%, and 13.43%). Multivariate adjusted regression analysis revealed that individuals in the highest quartile had 1.36-fold increased risk of diabetes compared with those in the lowest quartile of serum uric acid (odds ratio (95% confidence interval) = 1.36 (1.06−1.73)). Stratified analysis indicated that the association was only observed in women. Accordingly, serum uric acid was associated with the increased risk of incident diabetes among middle-aged and elderly Chinese women.
Keywords incident diabetes      prospective study      uric acid     
Corresponding Author(s): Yuhong Chen,Jieli Lu   
Just Accepted Date: 10 January 2020   Online First Date: 30 April 2020    Issue Date: 24 December 2020
 Cite this article:   
Di Cheng,Chunyan Hu,Rui Du, et al. Serum uric acid and risk of incident diabetes in middle-aged and elderly Chinese adults: prospective cohort study[J]. Front. Med., 2020, 14(6): 802-810.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-019-0723-7
https://academic.hep.com.cn/fmd/EN/Y2020/V14/I6/802
Fig.1  Flowchart of the study participants.
Serum uric acid, μmol/L ?Ptrend
Quartile 1 Quartile 2 Quartile 3 Quartile 4
No. of participants, n (%) 1493 (25.06) 1493 (25.00) 1490 (25.01) 1489 (24.93)
Age (year) 56.40±9.12 56.69±8.47 57.79±8.84 59.48±9.08 ?<0.0001
BMI (kg/m2) 23.79±2.92 24.59±2.86 25.27±3.17 26.16±3.17 ?<0.0001
Waist circumference (cm) 78.07±8.13 80.78±7.90 82.85±8.66 85.14±8.26 ?<0.0001
Educational attainment (high school or above), n (%) 301 (20.23) 315 (21.23) 322 (21.68) 266 (17.97) ?0.09
Current smoker, n (%) 316 (22.33) 291 (20.98) 295 (20.85) 257 (18.29) ?0.20
Current drinker, n (%) 117 (8.22) 146 (10.45) 167 (11.79) 165 (11.69) ?0.01
Physically active, n (%) 186 (12.49) 214 (14.38) 231 (15.55) 235 (15.80) ?0.006
SBP (mmHg) 135.10±18.72 138.59±19.07 140.27±19.65 144.13±19.43 ?<0.0001
DBP (mmHg) 80.37±10.07 82.33±9.98 83.34±10.16 84.62±10.30 ?<0.0001
Family history of diabetes, n (%) 110 (7.39) 142 (9.54) 124 (8.34) 153 (10.28) ?0.02
FPG (mmol/L) 5.03±0.55 5.07±0.54 5.11±0.56 5.16±0.56 ?<0.0001
2-h PPG (mmol/L) 6.23±1.59 6.50±1.66 6.74±1.73 7.14±1.79 ?<0.0001
HbA1c (%) 5.5 (5.3–5.7) 5.5 (5.3–5.7) 5.6 (5.3–5.8) 5.6 (5.4-5.8) ?<0.0001
Fasting cholesterol (mmol/L) 5.14±0.93 5.33±0.92 5.35±0.98 5.53±1.08 ?<0.0001
Fasting HDL cholesterol (mmol/L) 1.44±0.34 1.36±0.31 1.32±0.30 1.27±0.31 ?<0.0001
Fasting LDL cholesterol (mmol/L) 3.01±0.80 3.19±0.80 3.22±0.85 3.33±0.89 ?<0.0001
Fasting TGs (mmol/L) 1.03 (0.78–1.41) 1.25 (0.94–1.76) 1.40 (1.03–1.93) 1.69 (1.24–2.38) ?<0.0001
eGFR 103.87±9.09 101.70±9.37 98.90±9.99 94.27±13.40 ?<0.0001
Tab.1  Baseline clinical and biochemical characteristics of participants stratified by using the sex-specific quartiles of serum uric acid levels
Fig.2  Associations between FPG, 2-h PPG, and HbA1c levels at 4.5-year follow-up visit with baseline serum uric acid levels. (A) FPG levels at 4.5-year follow-up point based on uric acid quartiles at baseline. (B) 2-h PPG levels in 75-g OGTT at 4.5-year follow-up point based on uric acid quartiles at baseline. (C) HbA1c levels at 4.5-year follow-up point based on uric acid quartiles at baseline. Note: data are expressed as mean±SD for FPG, 2-h PPG levels and median (interquartile range) for HbA1c levels.
Baseline Follow-up
R P value R P value
FPG 0.089 <0.0001 0.102 <0.0001
2-h PPG 0.118 <0.0001 0.123 <0.0001
HbA1c 0.065 <0.0001 0.072 <0.0001
TGs 0.303 <0.0001 0.187 <0.0001
TC 0.039 0.003 −0.010 0.48
LDL cholesterol 0.050 0.0001 −0.015 0.29
HDL cholesterol −0.268 <0.0001 −0.051 0.0002
eGFR −0.361 <0.0001 −0.215 <0.0001
Tab.2  Pearson’s correlation analysis for the relationship of baseline serum uric acid levels and biochemistry measurements at baseline and follow-up visits, respectively
RR (95% CI) Ptrend
Quartile 1 Quartile 2 Quartile 3 Quartile 4
Cases/N 111/1493 131/1493 171/1490 200/1489
Incidence of diabetes (%) 7.43 8.77 11.47 13.43 <0.0001
Model 1 1.00 1.18 (0.93–1.50) 1.54 (1.23–1.94) 1.81 (1.45–2.25) <0.0001
Model 2 1.00 1.17 (0.92–1.50) 1.50 (1.20–1.89) 1.70 (1.36–2.13) <0.0001
Model 3 1.00 1.12 (0.87–1.43) 1.26 (1.00–1.60) 1.30 (1.03–1.65) <0.0001
Model 4 1.00 1.15 (0.90–1.46) 1.25 (0.99–1.58) 1.36 (1.06–1.73) <0.0001
Tab.3  Relative risk (95% CI) of incident diabetes for baseline serum uric acid quartiles
Incidence of RR (95% CI) Ptrend P for interaction
diabetes (%) Quartile 1 Quartile 2a Quartile 3a Quartile 4a
Age (year)
<60 8.81 1.00 1.23 (0.88–1.72) 1.44 (1.04–1.99) 1.58 (1.13–2.21) <0.0001 0.03
≥60 12.80 1.00 1.02 (0.71–1.46) 1.03 (0.73–1.45) 1.06 (0.75–1.49) 0.02
Sex
Male 11.43 1.00 1.01 (0.71–1.46) 1.001 (0.70–1.42) 1.06 (0.73–1.52) 0.10 0.68
Female 9.65 1.00 1.28 (0.92–1.79) 1.46 (1.06–2.01) 1.58 (1.13–2.20) <0.0001
BMI (kg/m2)
<24 6.70 1.00 1.01 (0.67–1.52) 1.16 (0.77–1.77) 1.06 (0.65–1.73) 0.54 0.0001
≥24 12.61 1.00 1.29 (0.94–1.75) 1.41 (1.05–1.89) 1.60 (1.20–2.15) <0.0001
Physically active
No 10.29 1.00 1.17 (0.90–1.52) 1.31 (1.01–1.68) 1.40 (1.07–1.82) <0.0001 0.86
Yes 10.39 1.00 1.03 (0.53–1.98) 0.96 (0.52–1.78) 1.18 (0.66–2.12) 0.02
Current smoker
No 10.45 1.00 1.26 (0.95–1.66) 1.33 (1.01–1.74) 1.52 (1.16–2.00) <0.0001 0.08
Yes 9.58 1.00 0.83 (0.48–1.43) 1.01 (0.62–1.64) 0.81 (0.46–1.42) 0.48
Current drinker
No 10.09 1.00 1.15 (0.89–1.49) 1.21 (0.94–1.55) 1.41 (1.09–1.82) <0.0001 0.24
Yes 11.93 1.00 1.14 (0.53–2.49) 1.44 (0.75–2.76) 0.92 (0.44–1.93) 0.31
Hypertension
No 6.72 1.00 1.38 (0.92–2.06) 1.55 (1.03–2.32) 1.60 (1.04–2.45) 0.002 0.12
Yes 13.01 1.00 1.02 (0.75–1.38) 1.11 (0.84–1.47) 1.20 (0.90–1.60) 0.0009
Highschool or above educational attainment
No 10.29 1.00 1.11 (0.85–1.45) 1.23 (0.95–1.59) 1.29 (0.98–1.68) <0.0001 0.25
Yes 9.97 1.00 1.48 (0.81–2.71) 1.43 (0.80–2.53) 1.76 (1.004–3.08) <0.0001
Family history of diabetes
No 9.75 1.00 1.21 (0.93–1.56) 1.21 (0.94–1.56) 1.33 (1.02–1.73) <0.0001 <0.0001
Yes 15.88 1.00 0.87 (0.44–1.75) 1.62 (0.88–3.00) 1.53 (0.83–2.81) 0.005
IGR
No 2.24 1.00 0.91 (0.44–1.89) 0.97 (0.45–2.08) 1.14 (0.48–2.72) 0.54 <0.0001
Yes 17.01 1.00 1.16 (0.90–1.51) 1.31 (1.02–1.68) 1.30 (1.01–1.68) 0.0001
Tab.4  Subgroup analysis for the association between sex-specific serum uric acid levels and risk of incident diabetes
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