Department of Endocrinology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Southeast University, Nanjing, China.
Front Endocrinol (Lausanne). 2020 Sep 2;11:577. doi: 10.3389/fendo.2020.00577. eCollection 2020.
Serum uric acid levels have been shown to be associated with increased risk of diabetes. However, it remains unclear whether uric acid-lowering therapy (ULT) is associated with improved glycemic status. This study aimed to summarize evidence from randomized controlled trials (RCTs) to investigate whether ULT reduces fasting blood glucose (FBG) and glycated hemoglobin A1c (HbA1c) levels. PubMed, Embase, and the Cochrane Library were searched from inception until April 10, 2019. Moreover, in order to maximize the search for articles on the same topic, the reference lists of included studies, relevant review articles and systematic reviews were reviewed. Parallel RCTs investigating the effect of ULT on FBG or HbA1c levels were considered for inclusion. An English language restriction was applied. Data were screened and extracted independently by two researchers. Meta-analyses were performed using random-effects models to calculate the weighted mean differences (WMDs) and 95% confidence intervals (CIs). Four trials with 314 patients reported the effect of ULT with allopurinol on FBG and 2 trials with 141 patients reported the effect of ULT with allopurinol on HbA1c. Treatment with allopurinol resulted in a significant decrease in FBG (WMD: -0.61 mmol/L, 95% CI: -0.93 to -0.28), but only a trend of reduction in HbA1c (WMD: -0.47%, 95% CI: -1.16 to 0.22). Notably, the subgroup analyses showed that treatment with allopurinol was associated with reduced FBG levels in patients without diabetes (WMD: -0.60 mmol/L, 95% CI: -0.99 to -0.20), but not in patients with diabetes. In addition, the dose of allopurinol treatment ≥200 mg daily resulted in a reduction of FBG levels (WMD: -0.59 mmol/L, 95% CI: -0.95 to -0.23), whereas low-dose allopurinol (<200 mg daily) had no effect on FBG levels. The findings suggest that ULT with allopurinol may be effective at reducing glycemia, but such an improvement does not appear to be observed in patients with diabetes. The findings require confirmation in additional trials with larger sample sizes.
血清尿酸水平与糖尿病风险增加有关。然而，尿酸降低治疗（ULT）是否与改善血糖状态相关仍不清楚。本研究旨在总结随机对照试验（RCTs）的证据，以调查 ULT 是否降低空腹血糖（FBG）和糖化血红蛋白 A1c（HbA1c）水平。检索了 PubMed、Embase 和 Cochrane 图书馆，检索时间截至 2019 年 4 月 10 日。此外，为了最大限度地查找关于同一主题的文章，还查阅了纳入研究的参考文献列表、相关综述和系统评价。纳入了研究 ULT 对 FBG 或 HbA1c 水平影响的平行 RCTs。应用了英语语言限制。两名研究人员独立筛选和提取数据。采用随机效应模型进行荟萃分析，计算加权均数差值（WMDs）和 95%置信区间（CIs）。四项研究（314 例患者）报告了别嘌呤醇 ULT 的作用对 FBG 的影响，两项研究（141 例患者）报告了别嘌呤醇 ULT 的作用对 HbA1c 的影响。别嘌呤醇治疗导致 FBG 显著降低（WMD：-0.61mmol/L，95%CI：-0.93 至-0.28），但 HbA1c 仅呈降低趋势（WMD：-0.47%，95%CI：-1.16 至 0.22）。值得注意的是，亚组分析显示，别嘌呤醇治疗与无糖尿病患者的 FBG 水平降低相关（WMD：-0.60mmol/L，95%CI：-0.99 至-0.20），但与糖尿病患者无关。此外，每天 200mg 以上剂量的别嘌呤醇治疗导致 FBG 水平降低（WMD：-0.59mmol/L，95%CI：-0.95 至-0.23），而低剂量别嘌呤醇（<200mg/天）对 FBG 水平无影响。研究结果表明，别嘌呤醇 ULT 可能有效降低血糖，但这种改善似乎在糖尿病患者中并不明显。需要更大样本量的额外试验来证实这些发现。
