Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Division of Rheumatology, Department of Medicine, University of Sherbrooke and Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-CIUSSSE-CHUS, Sherbrooke, QC, Canada.
Rheumatology (Oxford). 2024 Nov 1;63(11):2976-2980. doi: 10.1093/rheumatology/keae439.
Despite the well-established association between prediabetes and hyperuricaemia, knowledge about serum urate (SU) trends during the prediabetic phase is limited. Therefore, we aimed to assess the longitudinal changes of SU in individuals with prediabetes.
Individuals with prediabetes, defined by initial haemoglobin A1c (HbA1c) levels between 5.7% and 6.4%, were identified using electronic health records from an academic health system (2007-2022). We required at least one SU test before and after the prediabetes diagnosis. The primary outcome was the longitudinal SU trends during the follow-up period, estimated with a multivariable mixed-effects model. Patients were censored at diabetes onset. Marginal effects of covariates on SU changes were estimated. Subsequent analyses examined SU variations in subgroups stratified by age, sex, BMI, HbA1c, estimated glomerular filtration rate and metformin use.
Out of 25 526 individuals with prediabetes, 1521 met the SU cohort requirements, contributing to 6832 SU observations. At baseline, median age was 63 years and 40% were female. Median values were SU 6.3 mg/dl, HbA1c 5.9% and BMI 30 kg/m2. Median follow-up was 7.4 years. Older age, male sex, greater BMI and higher HbA1c were significant predictors of increased longitudinal SU levels. Individuals with a BMI ≥30 kg/m2 exhibited higher SU levels compared with those with lower BMI values.
Among individuals with prediabetes, several baseline variables were significant predictors of increased SU levels over time. These longitudinal trends in SU, support the potential for early intervention during the prediabetic phase, possibly reducing the risk of gout.
尽管糖尿病前期与高尿酸血症之间存在明确关联，但对糖尿病前期阶段血清尿酸（SU）趋势的了解有限。因此，我们旨在评估糖尿病前期患者 SU 的纵向变化。
使用学术医疗系统的电子健康记录（2007-2022 年）确定糖尿病前期患者，其初始血红蛋白 A1c（HbA1c）水平在 5.7%-6.4%之间。我们要求至少在糖尿病前期诊断前和后进行一次 SU 测试。主要结局是在随访期间 SU 的纵向趋势，使用多变量混合效应模型进行估计。患者在糖尿病发病时被删失。估计协变量对 SU 变化的边际效应。随后的分析检查了按年龄、性别、BMI、HbA1c、估算肾小球滤过率和二甲双胍使用分层的亚组中 SU 的变化。
在 25526 例糖尿病前期患者中，有 1521 例符合 SU 队列要求，共贡献了 6832 次 SU 观察值。基线时，中位年龄为 63 岁，40%为女性。中位数为 SU 6.3mg/dl、HbA1c 5.9%和 BMI 30kg/m2。中位随访时间为 7.4 年。年龄较大、男性、BMI 较高和 HbA1c 较高是 SU 水平随时间增加的显著预测因素。BMI≥30kg/m2 的个体与 BMI 值较低的个体相比，SU 水平更高。
在糖尿病前期患者中，一些基线变量是随时间推移 SU 水平增加的显著预测因素。SU 的这些纵向趋势支持在糖尿病前期阶段进行早期干预的潜力，可能降低痛风风险。
