Correlation Between SUA And Progression Of T2DM Retinopathy And Other Risk Factors

1 Background and ObjectivesIn developing countries,the prevalence of diabetes is growing at an alarming rate.Epidemiological surveys show that this trend is related to changes in diet and lifestyle,urbanization and population ageing.With the increasing prevalence of diabetes worldwide,microvascular complications such as diabetic retinopathy(DR)have become a common public health problem worldwide.DR is a typical microvascular disease of DM,which is the main cause of blindness in the working population.It is well known that early intervention and timely treatment of risk factors in patients with type 2 diabetes mellitus(T2DM)can prevent diabetes-related deterioration of vision and reduce the risk of blindness.A large number of studies at home and abroad have shown that independent risk factors for DR include glycosylated hemoglobin(HbA1c),systolic blood pressure(SBP)and duration of diabetes,but whether SUA levels,lipid,C peptide,urine albumin/urine creatinine(UACR)and body mass index(BMI)are independent risk factors of DR remains controversial.Therefore,we collected the baseline SUA level and other baseline clinical data of 648 patients with T2 DM and followed up the results of fundus examination after 3 years,to explore the correlation between baseline SUA level and DR progress in patients with T2 DM,and to analyze other related risk factors affecting DR progress,so as to intervene risk factors early,prevent the occurrence of DR in patients with T2 DM,delay the progress of DR and reduce the risk of blindness.2 Materials and MethodsA retrospective cohort study was conducted to enroll 648 patients with T2 DM who were admitted to the Department of Endocrinology,Second Affiliated Hospital of Zhengzhou University from January 2013 to January 2015.The general baseline data were collected as follows: gender,age,course of disease,smoking history,BMI,SBP and diastolic blood pressure(DBP);and the baseline laboratory indicators were collected as follows: HbA1 c,fasting plasma glucose(FPG),high-density lipoprotein cholesterol(HDL-C),serum total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),triglyceride(TG),serum creatinine(SCr),Blood urea nitrogen(BUN),SUA,and UACR.The baseline fundus of the study subjects was collected,and the progress of DR after 3 years was tracked.According to whether DR progressed,the subjects were divided into progressive group and non-progressive group.The data were analyzed by SPSS 21.0.3 Results 3.1 Univariate analysisCompared with the progress rate of DR at different SUA levels,the results showed statistically significant differences(?2=27.257 P<0.05).The course of disease,SBP,DBP,HbA1 c,TG,LDL-C,UACR and SUA in the progressive group were higher than those in the non-progressive group,and the C-peptide was lower than that in the non-progressive group,with statistical significance(P<0.05).The course of disease,SBP,DBP,HbA1 c,TG,LDL-C,UACR and SUA may be risk factors for DR progression.There were no significant differences in age,gender,smoking history,BMI,BUN,SCr,TC,and HDL-C between the progressive group and the nonprogressive group(P>0.05).3.2 Multivariable analysisSUA>291.00?mol/l is an independent risk factor for DR progression.Compared with the lowest quartile array of SUA,the OR(95% CI)values of the third quartile array and the highest quartile array were 5.194(2.162-12.482)and 6.680(2.785-16.022),P<0.05.The duration of diabetes,SBP,HbA1 c,TG and UACR were independent risk factors for DR progression,and their OR(95% CI)values were 1.070(1.037-1.103),1.020(1.004-1.037),1.231(1.036-1.462),1.357(1.132-1.626)and 1.003(1.001-1.006),respectively,all P<0.05.4 Conclusion4.1 Different levels of SUA have different effects on DR progression.High levels of SUA(>291.00?mol/l)are an independent risk factors for DR progression in patients with T2 DM.4.2 The duration of diabetes,SBP,HbA1 c,TG and UACR are also independent risk factors for DR progression in patients with T2 DM.