High Serum Uric Acid and Increased Risk of Type 2 Diabetes: A Systemic Review and Meta-Analysis of Prospective Cohort Studies

Qin Lv(Union Hospital), Xianfang Meng(Huazhong University of Science and Technology), Fang-Fang He(Huazhong University of Science and Technology), Shan Chen(Huazhong University of Science and Technology), Hua Su(Huazhong University of Science and Technology), Jing Xiong(Huazhong University of Science and Technology), Pan Gao(Huazhong University of Science and Technology), Xiujuan Tian(Huazhong University of Science and Technology), Jianshe Liu(Union Hospital), Zhonghua Zhu(Huazhong University of Science and Technology), Kai Huang(Huazhong University of Science and Technology), Chun Zhang(Union Hospital)
PLoS ONE
February 20, 2013
10.1371/journal.pone.0056864
Cited by 355Open Access
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Abstract

OBJECTIVE: Current evidence suggests high serum uric acid may increase the risk of type 2 diabetes, but the association is still uncertain. The aim of the study was to evaluate the association between serum uric acid and future risk of type 2 diabetes by conducting a meta-analysis of prospective cohort studies. DESIGN AND METHODS: We conducted a systematic literature search of the PubMed database through April 2012. Prospective cohort studies were included in meta-analysis that reported the multivariate adjusted relative risks (RRs) and the corresponding 95% confidence intervals (CIs) for the association between serum uric acid and risk of type 2 diabetes. We used both fix-effects and random-effects models to calculate the overall effect estimate. The heterogeneity across studies was tested by both Q statistic and I(2) statistic. Begg's funnel plot and Egger's regression test were used to assess the potential publication bias. RESULTS: We retrieved 7 eligible articles derived from 8 prospective cohort studies, involving a total of 32016 participants and 2930 incident type 2 diabetes. The combined RR of developing type 2 diabetes for the highest category of serum uric acid level compared with the lowest was 1.56(95% CI, 1.39-1.76). Dose-response analysis showed the risk of type 2 diabetes was increased by 6% per 1 mg/dl increment in serum uric acid level (RR 1.06, 95% CI: 1.04-1.07). The result from each subgroup showed a significant association between serum uric acid and risk of type 2 diabetes. In sensitive analysis, the combined RR was consistent every time omitting any one study. Little evidence of heterogeneity and publication bias was observed. CONCLUSIONS: Our meta-analysis of prospective cohort studies provided strong evidence that high level of serum uric acid is independent of other established risk factors, especially metabolic syndrome components, for developing type 2 diabetes in middle-aged and older people.

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