Relationship Between Four Non-Insulin-Based Indexes of Insulin Resistance and Serum Uric Acid in Patients with Type 2 Diabetes: A Cross-Sectional Study

Figures & data

Table 1 Comparisons of Clinical Characteristics of T2DM Patients with Different SUA Levels

	SUA≤180umol/l (n=77)	180 umol/l <SUA≤300umol/l (n=324)	SUA>300 umol/l (n=286)	P
Hypertension (%)	50(64.93%)	222(68.52%)	214(74.82%)	0.115
DN (%)	58(75.32%)	236(72.84%)	227(79.37%)	0.170
Sex male (%)	35(45.45%)	166(51.23%)	176(61.54%)^ab	0.008
Age (year)	50.32±16.58	54.20±16.85	52.48±17.03	0.148
Diabetic duration (year)	7.00(2.00,11.50)	7.50(3.00,12.00)	9.00(4.00,13.00)	0.139
SBP (mmHg)	146.56±23.43	145.39±22.25	147.24±20.41	0.570
DBP (mmHg)	82.92±15.03	83.90±15.64	83.81±15.13	0.878
Height (cm)	167.52±8.69	166.74±8.39	168.26±8.76	0.092
Weight (kg)	71.09±17.19	71.21±15.26	75.75±16.34^ab	0.001
BMI (kg/m2)	25.33±5.76	25.60±5.03	26.67±4.87^ab	0.015
BUN (mmol/L)	5.19±1.59	5.73±1.81^a	6.54±2.02^ab	<0.001
CR (μmol/L)	60.61±19.58	65.77±19.38	73.95±24.14^ab	<0.001
TG (mmol/L)	1.12(0.88,1.48)	1.69(1.05,2.31)^a	3.14(1.77,4.81)^ab	<0.001
TC (mmol/L)	5.24±1.31	5.38±1.24	5.82±1.11^ab	<0.001
HDL-c (mmol/L)	1.30±0.44	1.28±0.37	1.17±0.31^ab	<0.001
LDL-c (mmol/L)	3.43±1.14	3.60±1.16	3.77±1.13^a	0.045
HbA1c (%)	10.70(9.25,12.75)	10.10(7.70,12.47)	8.55(6.70,10.70)^ab	<0.001
FBG (mmol/L)	12.04(9.20,14.53)	10.00(7.61,12.64)^a	9.98(7.59,12.76)^a	<0.001
AER (mg/24h)	99.51(30.30,232.56)	128.33(26.74,288.54)	211.55(52.82,723.78)^ab	<0.001
eGFR (mL/min/1.73m^2)	128.58(94.78,165.29)	112.07(87.37,155.50)	104.09(81.67,139.36)^ab	<0.001

Notes: ^acompared with SUA≤180umol/l group, P<0.05; ^bcompared with 180 umol/l <SUA≤300umol/l group, P<0.05.

Abbreviations: T2DM, type 2 diabetes; SUA, serum uric acid; DN, diabetic nephropathy; SBP, systolic blood pressure; DBP, diastolic blood pressure; BMI, body mass index; BUN, blood urea nitrogen; CR, creatinine; TG, triglyceride; TC, total cholesterol; HDL-c, high-density lipoprotein cholesterol; LDL-c, low-density lipoprotein cholesterol; HbA1c, hemoglobin A1C; FBG, fasting blood glucose; AER, albumin excretion rate; eGFR, estimated glomerular filtration rate.

Figure 1 Comparison of four non-insulin-based IR indexes at different serum uric acid (SUA) levels. (A) difference of triglyceride and glucose index (TyG) among the three groups; (B) difference of TyG index with body mass index (TyG-BMI) among the three groups; (C) difference of the ratio of triglycerides divided by high-density lipoprotein cholesterol (TG/HDL-c) among the three groups; (D) difference of metabolic score for insulin resistance (METS-IR) among the groups.

Table 2 Correlations Between SUA Level and Clinical Variables

	r	P
SUA (umol/l)	1.000
Age (year)	−0.045	0.242
Diabetic duration (year)	0.110	0.004
SBP (mmHg)	0.046	0.227
DBP (mmHg)	0.050	0.187
Height (cm)	0.106	0.005
Weight (kg)	0.177	<0.001
BMI (kg/m2)	0.147	<0.001
BUN (mmol/L)	0.293	<0.001
CR (μmol/L)	0.255	<0.001
TG (mmol/L)	0.492	<0.001
TC (mmol/L)	0.208	<0.001
HDL-c (mmol/L)	−0.138	<0.001
LDL-c (mmol/L)	0.106	0.005
HbA1c (%)	−0.278	<0.001
FBG (mmol/L)	−0.090	0.018
AER (mg/24h)	0.175	<0.001
eGFR (mL/min/1.73m^2)	−0.210	<0.001
TyG	0.406	<0.001
TyG-BMI	0.272	<0.001
TG/HDL-c	0.493	<0.001
METS-IR	0.238	<0.001

Abbreviations: SUA, serum uric acid; SBP, systolic blood pressure; DBP, diastolic blood pressure; BMI, body mass index; BUN, blood urea nitrogen; CR, creatinine; TG, triglyceride; TC, total cholesterol; HDL-c, high-density lipoprotein cholesterol; LDL-c, low-density lipoprotein cholesterol; HbA1c, hemoglobin A1C; FBG, fasting blood glucose; AER, albumin excretion rate; eGFR, estimated glomerular filtration rate; TyG, triglyceride and glucose index; TyG-BMI, TyG index with body mass index; TG/HDL-c, the ratio of triglycerides divided by high-density lipoprotein cholesterol; METS-IR, metabolic score for insulin resistance.

Figure 2 Correlation between serum uric acid (SUA) and four non-insulin-based IR indexes in T2DM. (A) correlation between SUA and triglyceride and glucose index (TyG); (B) correlation between SUA and TyG index with body mass index (TyG-BMI); (C) correlation between SUA and the ratio of triglycerides divided by high-density lipoprotein cholesterol (TG/HDL-c); (D) correlation between SUA and metabolic score for insulin resistance (METS-IR).

Table 3 Multiple Regression Analysis of Four Non-Insulin-Based IR Indexes Correlated with SUA in T2DM

		TyG	TyG-BMI	TG/HDL-c	METS-IR
Model 1	B	53.543	0.496	25.200	2.606
	T	11.327	7.416	113.354	6.945
	F	128.290	54.994	178.332	48.233
	R^2	0.157	0.073	0.205	0.064
	P	<0.001	<0.001	<0.001	<0.001
Model 2	B	52.622	0.456	25.122	2.396
	T	11.241	6.728	13.500	6.323
	F	37.854	16.953	52.260	15.590
	R^2	0.177	0.085	0.230	0.078
	P	<0.001	<0.001	<0.001	<0.001
Model 3	B	41.620	0.334	20.426	2.112
	T	9.706	5.520	11.972	6.303
	F	30.326	23.505	35.583	24.496
	R^2	0.357	0.299	0.396	0.308
	P	<0.001	<0.001	<0.001	<0.001

Notes: Model 1, unadjusted model; Model 2, basic adjusting model, adjusted for age, gender and diabetic duration; Model 3, fully adjusted model, additionally adjusting for systolic blood pressure (SBP), diastolic blood pressure (DBP); blood urea nitrogen (BUN); creatinine (CR); total cholesterol (TC); low-density lipoprotein cholesterol (LDL-c); hemoglobin A1C (HbA1c); estimated glomerular filtration rate (eGFR), and albumin excretion rate (AER).

Abbreviations: IR, insulin resistance; SUA, serum uric acid, T2DM, type 2 diabetes; TyG, triglyceride and glucose index; TyG-BMI, TyG index with body mass index; TG/HDL-c, the ratio of triglycerides divided by high-density lipoprotein cholesterol; METS-IR, metabolic score for insulin resistance.

Table 4 AUCs and Cutoff Values of Four Non-Insulin-Based IR Indexes for the Prediction of HUA in T2DM

	AUC (95% CI)	P	Cut-off value	Sensitivity	Specificity	Youden Index
TyG	0.693 (0.645,0.741)	<0.01	9.552	75.9%	53.1%	0.290
TyG-BMI	0.649 (0.599,0.699)	<0.01	255.503	66.2%	62.5%	0.287
TG/HDL-c	0.768 (0.726,0.811)	<0.01	1.795	76.6%	65.1%	0.417
METS-IR	0.660 (0.609,0.710)	<0.01	46.327	57.9%	71.0%	0.289

Abbreviations: AUC, area under the curve; IR, insulin resistance; HUA, hyperuricemia; T2DM, type 2 diabetes; CI, confidence interval; TyG, triglyceride and glucose index; TyG-BMI, TyG index with body mass index; TG/HDL-c, the ratio of triglycerides divided by high-density lipoprotein cholesterol; METS-IR, metabolic score for insulin resistance.

Figure 3 Receiver operating characteristic (ROC) curves for predicting HUA in T2DM.

Abbreviations: HUA, hyperuricemia; TyG, triglyceride and glucose index; TyG-BMI, TyG index with body mass index; TG/HDL-c, the ratio of triglycerides divided by high-density lipoprotein cholesterol; METS-IR, metabolic score for insulin resistance.