The Effect of Uric Acid Level, Hyperuricemia and Gout on the Risk of Type 2 Diabetes: A Meta-Analysis of Cohort Studies

Abstract

Background: Epidemiology evidence on the effect of serum uric acid levels (SUAs), hyperuricemia, and gout on the risk of type 2 diabetes (T2DM) is inconsistent. We conducted a meta-analysis of cohort studies to comprehensively summarize the issue. Methods: We searched the PubMed and Embase databases to November 2019 for studies conformed to the inclusion criteria. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated with random-effect meta-analysis. We conducted dose-response meta-analysis to investigate the relation between SUA and T2DM risk. Meta-regression analyses, subgroup analyses and sensitivity analyses were performed to identify potential sources of heterogeneity. Findings: A total of 23 prospective studies involving 737468 participants were identified. A significantly positive association between higher uric acid level, hyperuricemia, gout and T2DM risk was observed, respectively(RR=1.20, 95% CI 1.14, 1.27; RR=1.52, 95% CI 1.21, 1.91; RR=1.35, 95% CI 1.16, 1.57). Piecewise dose-response analysis found a linear trend for SUA higher than 4.5mg/dl, with one mg/dl increase of SUA level associated with 8% increase of T2DM risk (RR=1.08, 95%CI= 1.03, 1.13, P=0.001). Unadjusted for hypertension found a positive association between gout and T2DM risk (RR=1.40, 95% CI 1.22, 1.66), while adjusted for hypertension found the relation to be non-significant (RR=1.31, 95% CI 0.78, 2.21). Interpretation: The present findings suggest that higher SUA levels, hyperuricemia and gout are risk factors for T2DM. It is necessary for hyperuricemia and gout patients to test blood glucose regularly and prevent T2DM. For general population, lowering serum uric acid might protect from incident T2DM. Funding Statement: The authors stated that they received no funding for this work. Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: The authors planned and conducted this review under the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses: the PRISMA statement.