Correlation Analysis Between Gout,Hyperuricemia And Glucose Metabolism Indexes

Objective:This study aims to explore the difference of glucose metabolism indexes(fasting plasma glucose(FPG),glycosylated hemoglobin(Hb A1c)and insulin resistance index evaluated by homeostasis model(HOMA-IR))level between gout and hyperuricemia(HUA)patients.At the same time,the association between HUA and urinary glucose excretion(UGE)was also studied.Methods:From December 2012 to August 2021,gout patients who were admitted to the Department of Endocrine and Metabolic Diseases of the Affiliated Hospital of Qingdao University were collected retrospectively.The subjects who met the inclusion and exclusion criteria were classified as gout group,with a total of 410 subjects.In the same period,the other 410 subjects in the health check-up center of our hospital were 1:1 matched into healthy control group and HUA group according to gender and age(±2 years),so as to analyze the difference of glucose metabolism indexes between gout and HUA patients.In addition,from January 2018 to June 2020,the data of male patients with type 2 diabetes mellitus(T2DM)admitted to the hospital were also collected.We divided the patients into different groups in accordance with UGE level,namely normal UGE group(N group),slightly to moderately increased UGE group(M group)and severely increased UGE group(S group).Thus,the association involving UGE and HUA was explored.Results:1.In the subjects with normal glucose metabolism,the FPG of healthy control group,HUA group as well as gout group were(5.02±0.60),(5.17±0.69)and(5.32±0.52)mmol/L,respectively,showing a increasing trend(F=25.967,P<0.001).We didn’t find any statistically significant difference in Hb A1c among the three groups(F=1.371,P=0.254).From the healthy control group to HUA group,then to gout group,the fasting insulin level and HOMA-IR of the subjects showed an increasing trend(F=218.939～227.729,all P<0.001).The subjects of gout group were found to have a higher prevalence of abdominal obesity,hypertension and lower high density lipoprotein cholesterol(HDL-C)compared with HUA group and healthy control group(χ~2=3.200～121.680,all P﹤0.001).No differences on the above indexes existed when comparing HUA group with healthy control group(χ~2=0.312～3.848,all P﹥0.05).When hypertriglyceridemia was considered,the subjects in HUA group and gout group presented a higher prevalence rate than the healthy control group(χ~2=6.395,18.517,all P﹤0.05).However,the difference in prevalence rate between HUA group and gout group has not been observed(χ~2=3.200,P=0.074).The multivariate logistic regression analysis suggested that the rate of subjects with higher FPG in HUA group increased by 1.121 times compared with the healthy control group(P<0.001).A significant positive correlation was found to exist in gout and higher FPG after adjusting for variables such as age,body mass index(BMI),systolic blood pressure(SBP),serum uric acid(SUA),estimated glomerular filtration rate(e GFR),smoking,drinking(P<0.001).After further additional adjustment of HOMA-IR,the correlation between gout and higher FPG was no longer significant(P=0.819).The proportion of subjects with higher HOMA-IR in HUA group and gout group increased by 84.7%and 139.3%,respectively compared with the healthy control group when adjusting for variables such as age,drinking,BMI,SBP,FPG,triglyceride(TG),HDL-C,history of hyperlipemia,etc.(all P<0.001).2.Among male patients with T2DM,with the increase of UGE,the SUA levels of subjects in the N-group,M-group and S-group were(342.93±81.55),(318.67±80.52)and(298.33±84.23)μmol/L,and the prevalence of HUA among the three groups were 16.8%,9.9%and 6.6%,respectively,showing a decreasing trend(all P<0.001).A higher UGE level was considered to be related to the low risk of HUA by logistic regression analysis(P=0.008).The adjusted odds ratio(OR)and 95%confidence interval(CI)of M-group and S-group were 0.639(0.427,0.957)and 0.381(0.198,0.732)compared with N-group,respectively.The increase of age,e GFR and urine p H were also negatively correlated with HUA in addition to the increase of UGE.Further subgroup analysis showed that the risk of HUA in S-group was 80.0%lower than that in N-group among the subjects with diabetic duration<10 years(P<0.001).However,among the subjects with diabetic duration≥10years,the negative correlation between HUA and UGE was not significant(P=0.123).There was a significant interaction between UGE and the duration of T2DM on the risk of HUA(P=0.004).Conclusion:1.The level of FPG in gout group was the highest,followed by HUA group and the lowest in healthy control group among the people with normal glucose metabolism.No significant difference existed in Hb A1c among the groups.From the healthy control group to HUA group,then to gout group,the fasting insulin and HOMA-IR levels of the subjects showed an increasing trend in turn.The subjects of gout group were found to have a higher prevalence of abdominal obesity,hypertension and low HDL-C compared with HUA group and healthy control group.A significant positive correlation was found to exist in HUA and higher FPG.The positive correlation between gout and higher FPG was mediated by insulin resistance.Both HUA and gout were deemed to positively and independently correlate with HOMA-IR.2.With the increase of UGE,the SUA level as well as the prevalence of HUA of male T2DM patients gradually decreased.The elevated UGE level was related to the reduced risk of HUA,and the correlation only existed in patients with diabetic duration for less than10 years.There was a significant interaction between UGE and diabetic duration for HUA risk.Inducing UGE may be beneficial to the treatment of HUA in male T2DM patients with diabetic duration of less than 10 years.