High serum uric acid and increased risk of type 2 diabetes: a systemic review and meta-analysis of prospective cohort studies.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of prospective cohort studies
PubMed 23437258 · doi:10.1371/journal.pone.0056864
What was done
Authors conducted a systematic review and meta-analysis of prospective cohort studies retrieved from PubMed through April 2012. Studies reporting multivariable-adjusted relative risks (RRs) and 95% confidence intervals (CIs) for serum uric acid and incident type 2 diabetes were pooled using fixed-effects and random-effects models. Dose-response analysis, subgroup analyses, leave-one-out sensitivity analysis, heterogeneity testing (Q and I²), and publication bias assessments (Begg's and Egger's tests) were performed.
What was found
Seven articles covering 8 prospective cohort studies were included (32,016 participants, 2,930 incident type 2 diabetes cases). The pooled multivariable-adjusted RR comparing the highest to lowest serum uric acid category was 1.56 (95% CI, 1.39–1.76). Dose-response analysis demonstrated a 6% risk increase per 1 mg/dL increase in serum uric acid (RR 1.06, 95% CI: 1.04–1.07). The association remained consistent across all subgroups and leave-one-out sensitivity analyses, with little evidence of heterogeneity or publication bias.
Why it matters
This meta-analysis demonstrates that elevated serum uric acid is a consistent, dose-dependent, and independent prospective risk factor for the development of type 2 diabetes in middle-aged and older adults.
Limits
The search was restricted to a single database (PubMed). Being an observational meta-analysis, unmeasured confounding and reverse causality cannot be completely ruled out, and the abstract does not provide specific uric acid cutoffs across the constituent cohorts.
Cited by
- supports Elevated serum uric acid independently predicts the future development of hypertension, obesity, and diabetes.