Diabetes Prevalence and Serum Uric Acid: Observations among 10,000 Men in a Survey of Ischemic Heart Disease in Israel

Abstract

In 1963 a long-term incidence study of ischemic heart disease and hypertension was initiated in Israel. A total of 10,059 Jewish men over forty years of age in government service were surveyed. The initial examination included a medical history and determinations of blood sugar, cholesterol,and uric acid. There were 682 men designated as diabetic suspects, because of either a history of diabetes or a casual blood sugar value of at least 130 mg. or both. Results of previous glucose tolerance tests, fasting blood sugar estimates, and information about treatment were obtained from physicians and clinics, or a glucose tolerance test was done at the survey laboratory. For forty-three men not enough information was obtained to decide whether they actually had diabetes. Seventy-nine men were not diabetic, and sixty-two others were not diabetic but had abnormal glucose tolerance tests. The remaining 498 men were classified as diabetic, and of these 296 had a history of the disease and 202 were newly discovered in the survey. The prevalence of diabetes was directly related to age. When rates were standardized for age, however, men born in the Middle East, North Africa and Israel had 50 per cent more diabetes than the men born in Europe. Also, there was an association between the prevalence of newly discovereddiabetes and body mass. But this was observed in only one group with respect to prevalence of previously diagnosed diabetics (Middle East-North Africa). Similarly, serum cholesterol was found to have a direct relation to prevalence of newly discovered diabetes, but this association was not established with certainty in respect to the prevalence of previously diagnosed diabetes. A highly significant inverse relation was observed between diabetes and serum uric acid. Serum uric acid values were lower among men with a history of diabetes than those with newly discovered disease. Both groups had values significantly lower than those of the rest of the survey population, however. Men without diabetes but with slightly abnormal glucose tolerance tests had values similar to those of the nondiabetic subjects. It seemed probable that the lower values accompanied rather than preceded the disease. Possible mechanisms causing increased uric acid excretion in diabetes are discucoed.