Insulin resistance status and its relation to plasma uric acid levels in type-2 Diabetes mellitus
DOI:
https://doi.org/10.7439/ijbr.v9i7.4846Abstract
Insulin resistance is principle etiological factor for development and progression of type-2 diabetes mellitus and decreased insulin functional at cellular level leads to dyslipidemia which is significant cardiovascular risk factor. Apart from disturbances in glucose and lipid turnover it is claimed that uric acid is altered in type-2 diabetes mellitus, particularly leading to elevations in plasma uric acid levels, suggesting possible relationship among insulin resistance, diabetic dyslipidemia, uric acid levels and cardiovascular risk in type-2 diabetic patients. A study was planned to establish the relationship of plasma uric acid levels to insulin resistance thereby to assess its utility in identifying cardiovascular risk. Type-2 diabetic patients attending OPD of Subbaiah Institute of Medical Sciences and its affiliated hospitals, Shivamogga, in age group of 30-55 years were randomly selected(n=90). Age matched normal controls were taken from employees of Institute and Hospitals (n=90). Diabetic patients were into three groups based on their insulin resistance. Group-1 had insulin resistance between 2-3.5, Group-2 between 3.6-6 and Group-3 had insulin resistance level above 6.1. Fasting plasma levels of glucose, triacylglycerols, HDL cholesterol and uric acid were estimated. The insulin resistance was calculated using ratio of Triacylglycerols/HDL cholesterol. Results shows proportional raise in plasma uric acid levels in diabetic subjects in comparison to insulin resistance indicating plasma uric acid is a measure of insulin resistance in these patients. It can be concluded from present study that plasma uric acid estimation, a cost effective test, is clinically useful in ascertaining insulin resistance hence cardiovascular risk in type-2 diabetic patients.
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2. Brown MS, Goldstein JL. Selective versus total insulin resistance: a pathogenic paradox. Cell metabolism. 2008;7(2):95-6.
3. Reyes JA, Plancarte AA. Bases moleculares de las acciones de la insulina. Revista de Educación Bioquímica. 2008;27(1):9-18.
4. Laakso M, Barrett-Connor E. Asymptomatic hyperglycemia is associated with lipid and lipoprotein changes favoring atherosclerosis. Arteriosclerosis, Thrombosis, and Vascular Biology. 1989 ;9(5):665-72.
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9. Wang M, Zhao O, Wang W, Lin J & Lin S. A prospective study on relationship between blood uric acid levels, insulin sensitivity and insulin resistance. Chinese Journal of Internal Medicine. 2007;46: 824-26
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12. Herman J B,Medelie J H &Goldbourt U. Diabetes, prediabetes and uricemia. Diabetologia. 1976;12: 47-52.
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20. Meng T C, Fukuda T &Tonks NK . Reversible oxidation and inactivation of protein tyrosine phosphatase in vivo. Molecular Cell.2002; 9: 387-89.
21. Meng T C, Buckley DA, Galic S, Tiganis T &Tonks NK. Regulation of insulin signaling through reversible oxidation of the protein tyrosine phosphatases TC 45 and PTP1B. J.Biol. Chem. 2004; 279: 37716-725.
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26. Giannini C, Santoro N, Caprio S, Kim G, Lartaud D, Shaw M, Pierpont B, Weiss R. The Triglyceride-to-HDL Cholesterol Ratio: Association with insulin resistance in obese youths of different ethnic background. Diabetes care. 2011 ; DC_102234.
27. Paulmichl, K., Hatunic, M., Jotic, A., Krebs, M., Mitrakou, A., Porcellati, F., Tura, A., Bergsten, P., Forslund, A., Manell, H. and Widhalm, K., 2016. Modification and Validation of the Triglyceride-to–HDL Cholesterol Ratio as a Surrogate of Insulin Sensitivity in White Juveniles and Adults without Diabetes Mellitus: The Single Point Insulin Sensitivity Estimator (SPISE). Clinical chemistry.2016; 62(9): 1211-19.
28. Insulin resistance in type 2 diabetes. In Pickup JC .Textbook of diabetes, 3rd edition blackwell science. 2003; 22.1
29. Significance of plasma total cholesterol-VLDL cholesterol ratio (TC/VLDLC) in Type-2 diabetes mellitus. International Journal of Biomedical Research.2018;09(01):36-39
30. Hayden M R, Tyagi S C. Uric acid a new look at an old risk marker for cardiovascular disease, metabolic syndrome and type 2 ediabetes mellitus the urate redox shuttle.Nutr. Metab.( Lond )(Internet). 2004; 1 (10)..
31. Sinagra D, Scarpitta A M, Bonaventura V, Greco D, Perrone P, Picon G et al. Serum uric acid and insulin secretion in diabetes mellitus. Riv. Fur. Sci. Med. Farmacol.1996;18:173- 177
32. Importance of determining the presence and degree of insulin resistance in the general population: diabetalogica Crotica. 2005;34(01)
33. Mcfarlane SI, Banerji M, Sowers JR. Insulin resistance and cardiovascular disease. The Journal of Clinical Endocrinology & Metabolism. 2001;86(2):713-8.
34. Lehto S, Niskanen L, Rönnemaa T, Laakso M. Serum uric acid is a strong predictor of stroke in patients with non–insulin-dependent diabetes mellitus. Stroke. 1998;29(3):635-9.
35. Freedman DS, Williamson DF, Gunter EW, Byers T. Relation of serum uric acid to mortality and ischemic heart disease: the NHANES I Epidemiologic Follow-up Study. American journal of epidemiology. 1995;141(7):637-44.
36. Alderman MH, Cohen H, Madhavan S, Kivlighn S. Serum uric acid and cardiovascular events in successfully treated hypertensive patients. Hypertension. 1999;34(1):144-50.
37. Lee J, Sparrow D, Vokonas PS, Landsberg L, Weiss ST. Uric acid and coronary heart disease risk: evidence for a role of uric acid in the obesity-insulin resistance syndrome: the Normative Aging Study. American Journal of Epidemiology. 1995;142(3):288-94.
38. Sowers JR, Lester MA. Diabetes and cardiovascular disease. Diabetes care. 1999 ;22:C14.
39. Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. New England journal of medicine. 1997;336(14):973-9.
1. Shulman GI. Cellular mechanisms of insulin resistance. The Journal of clinical investigation. 2000 ;106(2):171-6.
2. Brown MS, Goldstein JL. Selective versus total insulin resistance: a pathogenic paradox. Cell metabolism. 2008;7(2):95-6.
3. Reyes JA, Plancarte AA. Bases moleculares de las acciones de la insulina. Revista de Educación Bioquímica. 2008;27(1):9-18.
4. Laakso M, Barrett-Connor E. Asymptomatic hyperglycemia is associated with lipid and lipoprotein changes favoring atherosclerosis. Arteriosclerosis, Thrombosis, and Vascular Biology. 1989 ;9(5):665-72.
5. Howard BV. Insulin resistance and lipid metabolism. The American journal of cardiology. 1999 ;84(1):28-32.
6. Kashinath R T &Patil K C. Whole blood uric acid levels in diabetics with or without lipaemia. J. Mys. Med. Assoc. 1972;36: 153-56
7. Kertes P J &Jhonson T M . Evidence based Eye care. Philidelphia. Lippincott Williams & Wilkins. 3. Butturini U, Coscelli C &Zavroni I (1977), Insulin release in hyperuricemic patients. Acta. Diab Lat. 2007; 14: 73-78
8. Sinagra D, Greco D, Scarpitta A M &Bonaventura V. Serum uric acid, insulin secretion and resistance in non-hyperuricemia and hyperuricemic obese female subjects. Int. J. Obes. Relat. Metab.Disord. 1996;20: 1041-43
9. Wang M, Zhao O, Wang W, Lin J & Lin S. A prospective study on relationship between blood uric acid levels, insulin sensitivity and insulin resistance. Chinese Journal of Internal Medicine. 2007;46: 824-26
10. Quinones G A, Natali A, Baldi S, Frascerra S, Sanna G, Ciociaro D etal. Effect of insulin on uric acid excretion in humans. Am. J. Endocrinol. Metab. 1995: 268: E1-E5
11. Medelie J H, Papier C M, Goldbourt U & Herman J B. Major factors in the development of diabetes mellitus in 10000 men. Arch. Int. Med. 1975;135: 811-17.
12. Herman J B,Medelie J H &Goldbourt U. Diabetes, prediabetes and uricemia. Diabetologia. 1976;12: 47-52.
13. Toumilehto J, Zimmet P, Wolf E, Taylor R, Ram P & King H. Plasma uric acid and its association with diabetes mellitus and some biological parameters in biracial population of Fizi. Am. J. Epidemiol. 1988;127: 321-36.
14. Nakanishi N, Okamoto M, Yoshida H, Matsuo Y, Suzuki K &Tatara K. Serum uric acid and risk for development of hypertension and impaired fasting glucose or type II diabetes in Japanese male office workers. Eur. J. Epidemiol. 2003; 18: 523-30.
15. Boyko E J, de Courten M, Zimmer P Z, Chitson P, TonmilhetoJ&Alberti K G. Features of the metabolic syndrome predict higher risk of diabetes and impaired glucose tolerance – a prospective study in Maurtius. Diabetes Care. 2000; 23: 1242-48.
16. Kashinath, R. T, Nagendra S &Srinivas S. Hyperuricemia in Type 2 Diabetes Mellitus. Global Journal of Medical Research. 2014;14(3).
17. Prashanthkumar G, Nagendra S, Kashinath RT. Plasma Uric Acid Levels in Relation to Plasma Cholesterol Levels in Type-2 Diabetes Mellitus. Global Journal of Medical Research. 2015; 29.
18. Wu J, Qiu L, Yan WH, Cheng XQ, Wu W, Guo XZ, Ding HT, Han HJ, Han SM, Zhu GJ. Serum γ-glutamyltransferase and uric acid levels are associated with impaired fasting glucose in adults from Inner Mongolia, China. BMC public health. 2013;13(1):294.
19. Mahdev K, Zilbering A, Zhu L & Goldstein B J. Insulin stimulated hydrogen peroxide reversibly inhibits protein tyrosine phosphatases in vivo and enhances the early insulin action cascade. J. Biol. Chem. 2001;276: 21938-942.
20. Meng T C, Fukuda T &Tonks NK . Reversible oxidation and inactivation of protein tyrosine phosphatase in vivo. Molecular Cell.2002; 9: 387-89.
21. Meng T C, Buckley DA, Galic S, Tiganis T &Tonks NK. Regulation of insulin signaling through reversible oxidation of the protein tyrosine phosphatases TC 45 and PTP1B. J.Biol. Chem. 2004; 279: 37716-725.
22. Cited in Practical Clinical Biochemistry by HeroldVarley, 4th Edn, Chapter-3, CBS publishers and distributors, New Delhi.2005; 82-83.
23. Tietz NW. Clinical guide to laboratory tests, 3rd edition by Saunders Philadelphia USA), 1995;624
24. Tietz NW. Clinical guide to laboratory tests, 3rd edition by Saunders Philadelphia USA), 1995;610.
25. Matsuzaki Y, Kawaguchi E, Morita Y, Mashige F, Ohisa S, Nakahara K. Evaluation of two kinds of reagents for direct determination of HDL-cholesterol. J Anal Bio-Sc. 1996;19:419-27.
26. Giannini C, Santoro N, Caprio S, Kim G, Lartaud D, Shaw M, Pierpont B, Weiss R. The Triglyceride-to-HDL Cholesterol Ratio: Association with insulin resistance in obese youths of different ethnic background. Diabetes care. 2011 ; DC_102234.
27. Paulmichl, K., Hatunic, M., Jotic, A., Krebs, M., Mitrakou, A., Porcellati, F., Tura, A., Bergsten, P., Forslund, A., Manell, H. and Widhalm, K., 2016. Modification and Validation of the Triglyceride-to–HDL Cholesterol Ratio as a Surrogate of Insulin Sensitivity in White Juveniles and Adults without Diabetes Mellitus: The Single Point Insulin Sensitivity Estimator (SPISE). Clinical chemistry.2016; 62(9): 1211-19.
28. Insulin resistance in type 2 diabetes. In Pickup JC .Textbook of diabetes, 3rd edition blackwell science. 2003; 22.1
29. Significance of plasma total cholesterol-VLDL cholesterol ratio (TC/VLDLC) in Type-2 diabetes mellitus. International Journal of Biomedical Research.2018;09(01):36-39
30. Hayden M R, Tyagi S C. Uric acid a new look at an old risk marker for cardiovascular disease, metabolic syndrome and type 2 ediabetes mellitus the urate redox shuttle.Nutr. Metab.( Lond )(Internet). 2004; 1 (10)..
31. Sinagra D, Scarpitta A M, Bonaventura V, Greco D, Perrone P, Picon G et al. Serum uric acid and insulin secretion in diabetes mellitus. Riv. Fur. Sci. Med. Farmacol.1996;18:173- 177
32. Importance of determining the presence and degree of insulin resistance in the general population: diabetalogica Crotica. 2005;34(01)
33. Mcfarlane SI, Banerji M, Sowers JR. Insulin resistance and cardiovascular disease. The Journal of Clinical Endocrinology & Metabolism. 2001;86(2):713-8.
34. Lehto S, Niskanen L, Rönnemaa T, Laakso M. Serum uric acid is a strong predictor of stroke in patients with non–insulin-dependent diabetes mellitus. Stroke. 1998;29(3):635-9.
35. Freedman DS, Williamson DF, Gunter EW, Byers T. Relation of serum uric acid to mortality and ischemic heart disease: the NHANES I Epidemiologic Follow-up Study. American journal of epidemiology. 1995;141(7):637-44.
36. Alderman MH, Cohen H, Madhavan S, Kivlighn S. Serum uric acid and cardiovascular events in successfully treated hypertensive patients. Hypertension. 1999;34(1):144-50.
37. Lee J, Sparrow D, Vokonas PS, Landsberg L, Weiss ST. Uric acid and coronary heart disease risk: evidence for a role of uric acid in the obesity-insulin resistance syndrome: the Normative Aging Study. American Journal of Epidemiology. 1995;142(3):288-94.
38. Sowers JR, Lester MA. Diabetes and cardiovascular disease. Diabetes care. 1999 ;22:C14.
39. Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. New England journal of medicine. 1997;336(14):973-9.
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Insulin resistance status and its relation to plasma uric acid levels in type-2 Diabetes mellitus. Int Jour of Biomed Res [Internet]. 2018 Jul. 31 [cited 2025 Mar. 12];9(7):263-7. Available from: https://ssjournals.co.in/index.php/ijbr/article/view/4846