目的:尽管糖尿病前期和高尿酸血症之间存在着明确的关联,关于糖尿病前期血清尿酸(SU)趋势的知识有限。因此,我们旨在评估糖尿病前期患者SU的纵向变化.
方法:糖尿病前期患者,由初始血红蛋白A1c(HbA1c)水平在5.7%至6.4%之间定义,使用学术卫生系统(2007-2022年)的电子健康记录进行识别。我们需要在糖尿病前期诊断前后至少进行一次SU检查。主要结果是随访期间的纵向SU趋势,用多变量混合效应模型估计。患者在糖尿病发作时被审查。估计了协变量对SU变化的边际效应。随后的分析检查了按年龄分层的亚组中的SU变化,性别,体重指数(BMI),HbA1c,估计肾小球滤过率(eGFR)和二甲双胍的使用。
结果:在25526名糖尿病前期患者中,1,521符合SU队列要求,为6832个SU观测做出贡献。在基线,中位年龄为63岁,40%为女性.中值为SU6.3mg/dl,HbA1c为5.9%,BMI为30kg/m2。中位随访时间为7.4年。年纪大了,男性,更大的BMI,和较高的HbA1c是纵向SU水平升高的显著预测因子。BMI≥30kg/m2的个体与BMI较低的个体相比,SU水平较高。
结论:在糖尿病前期患者中,几个基线变量是SU水平随时间增加的显著预测因子.SU的这些纵向趋势,支持糖尿病前期早期干预的潜力,可能会降低痛风的风险。
OBJECTIVE: 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.
METHODS: 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, body mass index (BMI), HbA1c, estimated glomerular filtration rate (eGFR) and metformin use.
RESULTS: Out of 25 526 individuals with prediabetes, 1,521 met the SU cohort requirements, contributing to 6,832 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.
CONCLUSIONS: 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.