Serum Uric Acid Levels Linked to Risk of Dyslipidemia in Type 2 Diabetes

Serum uric acid (SUA) levels representing hyperuricemia were significantly positively linked to dyslipidemia and hypertriglyceridemia in a cross-sectional study of hospitalized patients with type 2 diabetes (T2D).1

These data showed hyperuricemia, defined as SUA levels ≥420 µmol/L, accounted for more than two-fifths (40.3%) of the attributed risk for dyslipidemia in the population with T2D and hyperuricemia, and approximately 8% of the total population with T2D in the study.

“This study also highlights the potential role of SUA in the pathogenesis of dyslipidemia in T2D patients,” wrote the investigative team, led by Yan He, department of epidemiology and health statistics in the school of public health at Capital Medical University. “Our findings suggest a potential benefit of stricter control of SUA levels among patients with T2D in possibly reducing the risk of dyslipidemia.”

A common metabolic disturbance in diabetes, particularly in Chinese patients, dyslipidemia can notably raise the likelihood of atherosclerosis and cardiovascular complications.2 Recent literature in China has linked elevated SUA levels to dyslipidemia, but the connection becomes complex in people with diabetes, due to insulin resistance, diabetic complications, and anti-diabetic medications.3

Few investigations have measured this link in people with T2D, with He and colleagues noting this interaction could clarify the complex metabolic disturbances involved in dyslipidemia.1 For this cross-sectional study, the team evaluated the link between SUA and dyslipidemia in 1533 patients with T2D hospitalized between January 2019 and July 2022.

After exclusions due to age (n = 12), diagnosis of type 1 diabetes (n = 42), a lack of SUA data (n = 437), or receipt of uric acid-lowering medications (n = 6), 1036 patients were included in the final analysis. Multivariate logistic regression analysis tested the link between hyperuricemia and dyslipidemia, while restricted cubic spline (RCS) analysis was used to determine the optimal SUA level for lower dyslipidemia risk.

The mean age of participants was 48.6 years and 68.3% (n = 708) were men, with a mean SUA level of 286 µmol/L—among this population, 121 (11.8%) were identified with hyperuricemia. Those with hyperuricemia were more likely to be men, with higher systolic blood pressure (SBP), total cholesterol, and triglycerides, but lower hemoglobin A1c, estimated glomerular filtration rate (eGFR), and high-density lipoprotein cholesterol (HDL-C).

Investigators identified 524 participants (50.6%) with dyslipidemia, with a higher prevalence in the hyperuricemia cohort (78.5% vs. 46.9%; P <.001). After adjusting for potential confounders in multivariate logistic regression, including age, sex, BMI, and diabetes duration, the team found hyperuricemia significantly associated with dyslipidemia (odds ratio [OR], 3.72; 95% CI, 2.28–6.07) and hypertriglyceridemia (OR, 2.63; 95% CI, 1.68–4.12).

Further RCS analysis aimed to determine the optimal range for SUA corresponding with a lower dyslipidemia risk. After stratification by tertiles of SUA levels, multivariate logistic regression analysis found those in the highest tertile (SUA ≥320 µmol/L) had nearly a 2 times higher risk of dyslipidemia (OR, 1.79; 95% CI, 1.24–2.58), compared with the lowest tertile (SUA <250 µmol/L).

Noting insulin resistance is a common feature of T2D, with the possibility of abnormal triglyceride metabolism, He and colleagues examined the effect of SUA on the link between insulin resistance and triglycerides. Mediation analysis demonstrated a significant mediating effect of SUA on this connection (indirect effect, 0.08; P <.001), marking 20.1% of the total relationship.

Citing the lack of recommendations for SUA levels in diabetes, He and colleagues highlighted the urgent need to determine the optimal SUA levels in Chinese patients with T2D. They noted these data could provide new insight into the clinical application of SUA management in patients with T2D.

“The findings of this study suggest that the currently recommended SUA target level of 420 µmol/L may increase the risk of suffering from dyslipidemia in these patients. Conversely, maintaining SUA levels below 320 µmol/L might be an effective method for preventing hyperlipidemia and high triglycerides,” He and colleagues wrote.

References

1. Zhao M, Ma X, Xia Z, et al. Association between serum uric acid and dyslipidemia in type 2 diabetes: a cross-sectional study. BMJ Open. 2025;15(1):e087954. Published 2025 Jan 4. doi:10.1136/bmjopen-2024-087954
2. Schofield JD, Liu Y, Rao-Balakrishna P, Malik RA, Soran H. Diabetes Dyslipidemia. Diabetes Ther. 2016;7(2):203-219. doi:10.1007/s13300-016-0167-x
3. Chen S, Yang H, Chen Y, et al. Association between serum uric acid levels and dyslipidemia in Chinese adults: A cross-sectional study and further meta-analysis. Medicine (Baltimore). 2020;99(11):e19088. doi:10.1097/MD.0000000000019088