Study on the Risk Factors for Hyperuricaemia and Related Vascular Complications in Patients with Type 2 Diabetes Mellitus

Abstract

Purpose

The study aimed to identify diseases that exhibit significant differences between hyperuricaemia (HUA) and non-hyperuricaemia (NHUA) groups and analyse the risk factors for HUA based on the related diseases in type 2 diabetes mellitus (T2DM).

Methods

A total of 3264 T2DM patients were investigated from 2013 to 2017 in the Jinyang and Sanlin communities by obtaining basic data from the electronic medical record system (EMRS). From September 2018 to July 2019, 3000 patients (264 patients were missing during follow-up) were investigated with questionnaires, physical examinations and biochemical index tests. After removing missing values, 2899 patients were divided into HUA and NHUA groups. The chi-square test was used to identify diseases with differences. Using Lasso analysis and logistic regression analysis, risk factors for HUA based on the related diseases were obtained. The C-index, receiver operating characteristic (ROC) curve and calibration plot were used to validate the discrimination and accuracy of the factors.

Results

The chi-square test showed that there were significant differences in coronary heart disease (CHD) and diabetic nephropathy (DN) between the HUA group and the NHUA group. Through Lasso regression, glycosylated haemoglobin A1c (HbA1c), triglyceride (TG), blood urea nitrogen (BUN) and serum creatinine (SCR) were screened in the CHD group. Body mass index (BMI), HbA1c, total cholesterol (TC), TG, BUN, SCR and urine microalbumin (UMA) were screened in the DN group. The P-value of all the variables was less than 0.05. Through the C-index, calibration, and ROC curve analyses, these risk factors had medium accuracy.

Conclusion

HUA was significantly related to CHD and DN. The level of UA was correlated with HbA1c, TG, BUN, and SCR based on CHD. The level of UA was associated with BMI, HbA1c, TC, TG, BUN, SCR, and UMA based on DN.

Keywords:

• hyperuricaemia
• complications
• risk factors
• type 2 diabetes mellitus

Acknowledgments

The authors thank all the participating community health centres that helped recruit the participants, including Jinyang Community and Sanlin Community, and all participants who volunteered to be studied.

Abbreviations

DM, diabetes mellitus; IDF, International Diabetes Federation; T2DM, type 2 diabetes mellitus; CHD, coronary heart disease; DN, diabetic nephropathy; ESRD, end-stage renal disease; DR, diabetic retinopathy; UA, uric acid; HUA, hyperuricaemia; CKD, chronic kidney disease; NHUA, non-hyperuricaemia; EMRS, electronic medical record systems; SBP, systolic blood pressure; DBP, diastolic blood pressure; WHO, World Health Organization; BMI, body mass index; FBG, fasting blood glucose; HbA1c, glycosylated haemoglobin A1c; TC, total cholesterol; TG, triglyceride; HDL-C, high-density lipoprotein; LDL-C, low-density lipoprotein; BUN, blood urea nitrogen; SCR, serum creatinine; UCR, uric creatinine; UMA, urine microalbumin; HTN, hypertension; ETDRS, severity classification definition of early treatment diabetic retinopathy; PVR, proliferative vitreoretinopathy; ACR, urinary microalbumin-to-creatinine ratio; NAU, nonalbuminuria; MAU¸ microalbuminuria; CAU, clinical albuminuria; ECG, electrocardiogram; CT, computed tomography; MRI, magnetic resonance imaging; Lasso, lead absolute shrinkage and selection operator; OR, odds ratio; CI, confidence interval; ROC, receiver operating characteristic; IR, insulin resistance.

Ethics Statement

All participants were carefully informed about the protocol and provided written informed consent before inclusion in the study. The study was approved by the Shanghai Medical Ethics Committee and performed in accordance with the principles of the Declaration of Helsinki.

Disclosure

The authors declare no conflicts of interest in this work.

Additional information

Funding

This study was financially supported by the fourth round of Shanghai Public Health Three-Year Action Plan Key Discipline Construction–Health Education and Health Promotion (Grant No. 15GWZK1002).