Hypouricemia and hyperuricemia in type 2 diabetes: two different phenotypes

Background and Design Conflicting data exist about uric acid levels in type 2 diabetes mellitus, as low levels were found in diabetic patients, while elevated serum uric acid is a feature of hyperinsulinemia and impaired gluc ose tolerance. The present study was addressed to evaluate the relation bet ween uric acid and metabolic parameters, creatinine clearance and albumin e xcretion rate in a cohort of type 2 diabetic patients. Results Hyperuricemic patients were older and had higher values of body mas s index (BMI), systolic and diastolic blood pressure, triglycerides, albumi n excretion rate, C-peptide and prevalence of hypertension, metabolic syndr ome and macroalbuminuria and lower values of high-density lipoprotein (HDL) -cholesterol creatinine clearance and glycated haemoglobin (HbA(1c)). The c orrelations between uric acid levels and triglycerides, BMI, systolic blood pressure, albumin excretion rate, C-peptide, creatinine clearance, HDL-cho lesterol and HbA(1c) remained significant in a multiple regression analysis after adjustment for age, sex and duration of diabetes. After performing m ultiple logistic regression analyses, uric acid levels were independently a ssociated with hypertension [odds ratio (OR) = 1.8; 95% confidence interval (CI) 1.6-2], after adjustment for age, sex, duration of diabetes and macro albuminuria (OR = 1.5; 35% CI 1.1-2.0), after adjustment for age, sex, HbA( 1c) levels, creatinine clearance, duration of diabetes and blood pressure l evels and the metabolic syndrome (OR = 1.6; 95% CI 1.5-1.8), after adjustme nt for age, sex and creatinine clearance. Conclusions In type 2 diabetes, hyperuricemia seems to be associated with t he insulin-resistant syndrome and with early onset or increased progression to overt nephropathy, while hypouricemia is associated with worse metaboli c control, hyperfiltration and a late onset or decreased progression to ove rt nephropathy.