MS NO.: PJMDS/OA/006/2024

Original Article

Submitted: May 27, 2024

Revised: June 16, 2024

Accepted: August 16, 2024

Prevalence of Hyperuricemia in Smoker Population with Type 2 Diabetes Mellitus

Sooraj Kumar¹, Lata², Toseef Altaf Memon³, Naveed⁴

Corresponding Author

Sooraj Kumar¹

Email: [email protected]

Affiliations:

Liaquat University of Medical and Health Sciences (LUMHS),

Jamshoro^1,2,3

Indus Hospital Karachi⁴

Postgraduate Resident^1,2,4

Doctor of Medicine (MD)³

ABSTRACT

Objective: To determine the prevalence of hyperuricemia in smoker population with type 2 diabetes mellitus.

Methodology: This descriptive cross-sectional study was carried out in the Department of Medicine, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, from June to December 2021. The study was conducted involving smoking populated individuals diagnosed with type 2 diabetes mellitus. The diagnosed cases who fulfilled the inclusion criteria were included in the study. The participants' blood samples were taken to assess the uric acid to confirm hyperuricemia. The data was analyzed in SPSS version 26.0.

Results: In this study, a total of 576 diabetic patients diagnosed with type II were enrolled. The mean age was 51.31±13.76 an age range of 18 and 85 years. Males were dominant i.e. 66.7% v/s 33.3% females. Hyperuricemia was prevalent in 28.125% of patients.

Conclusion: It is to be concluded that hyperuricemia is prevalent in type II diabetic smoker patients. Since the study was conducted on a limited sample size from a single hospital, the findings may not accurately represent the situation across the entire country, and in order to generalise the results of our research, it must be assessed further in a broader sample of patients at other hospitals throughout the nation.

Keywords: Hyperuricemia, Prevalence, Smokers, Type II diabetes mellitus

INTRODUCTION

Diabetes is causing a sharp rise in morbidity and mortality in Pakistan; its prevalence has reached 17.1%¹. Type II diabetes mellitus has been found to have a substantial correlation with both blood uric acid levels and smokers². Insulin resistance is closely linked to metabolic syndrome (MS) and diabetes mellitus. The main components of metabolic syndrome are hypertension, hyperglycemia, hyperinsulinemia, and hyperlipidemia³. This has been shown to have independent risk factors, to be a lethal component of coronary heart disease (CHD), and to synergistically accelerate type II diabetes mellitus and non-diabetic atherscoleropathy as well as MS- related atherscoleropathy^3,4. Similarly, a study⁵ found that four parameters—highly sensitive C-reactive protein, reactive oxygen species, hyperuricemia, and hyperhomocysteinemia

are critical to the development of syndrome expansion.

Therefore, as a recommended screening strategy for type II diabetes mellitus, the population's greater risk of atherosclerosis needs to be determined⁶. Levels of serum uric acid and risk factors of cardiovascular disease have been shown to be strongly correlated⁷. Globally, there is rise in

diabetes mellitus type II and its increasing comorbidities, which greatly raises morbidity and death rates⁸. Hyperuricemia is the state in which one's serum uric acid level is unusually increased. Purine metabolism and breakdown under normal metabolic circumstances produce uric acid as a byproduct⁹. Purine metabolism involves two final processes, which are catalyzed by xanthine oxidoreductase. First, xanthine is converted from hypoxanthine to uric acid¹⁰. Urate, the monoanion of uric acid, is eliminated by urination and is thought to have minimal physiological significance at physiological pH levels¹¹. But purine metabolism can be disturbed for a variety of

reasons, some of which may be hereditary and others of which may be acquired, leading to an aberrant elevation in blood uric acid level (hyperuricemia) ¹². There is a hypothesis that links the

risk of type 2 diabetes to the amount of serum uric acid (SUA). Uric acid (UA) reduces the availability of nitric oxide, which is essential for insulin-stimulated glucose absorption. This reduction in availability leads to the physiologic worsening of insulin resistance in animal models¹³.

Moreover, there has been little research on the occurrence of hyperuricemia and its related variables in emerging nations, particularly in Asian areas. As far as we know, there have been just a few research conducted on this subject in Pakistan. Hence, the objective of this research was to ascertain the frequency of hyperuricemia among individuals who smoke and have type 2 diabetes mellitus. The study's results are expected to provide valuable insights for both physicians and researchers. Moreover, they may be beneficial for implementing strategies to mitigate metabolic problems linked to hyperuricemia.

METHODOLOGY

This descriptive cross-sectional study was conducted at the Department of Medicine at Liaquat University of Medical and Health Science (LUMHS) Jamshoro, from June 2021 to December 2021. A total of 576 participants were recruited using a non-probability consecutive sampling method. The study included patients of either gender, aged 20 to 70 years, who had been diagnosed with type II diabetes mellitus for more than 5 years. Participants who were smokers and presented with complaints related to type II diabetes mellitus were included in the study.

Exclusion criteria comprised individuals with major comorbidities, recent urological surgeries, immunodeficiency, or a history of alcohol consumption. Additionally, individuals with a history of chronic liver diseases, chronic renal failure, histologically diagnosed malignancies, cardiovascular diseases, or hypertension were also excluded from the study.

Approval for the study was granted by the institutional ethical review committee. All participants provided written informed consent, and confidentiality was maintained throughout the study. Demographic data were collected using a preset proforma after obtaining informed consent. Sociodemographic information such as age, sex, family history of diabetes mellitus, duration of diabetes, and smoking history was gathered. A physical examination was conducted, and quantitative characteristics, including weight, height, waist-tohip ratio (WHR), and body mass index (BMI), were recorded. Clinical measurements such as systolic blood pressure, diastolic blood pressure, and heart rate were also documented.

A 10 ml blood sample was collected from each participant for laboratory analysis. Postprandial blood sugar levels were estimated using the glucosoxidase-peroxidase method. Lipid profiles and blood urea levels were determined using the diacetyl monoxime method, while serum creatinine levels were measured using the alkaline picrate methodology.

Continuous data were reported as the number of cases with corresponding percentages and were compared using the Chi-square test. The Chi-square test was also used to compare categorical variables, with significance set at a p-value of less than 0.05. Statistical analysis was performed using SPSS version 26.0.

RESULTS

Table I presents the demographic characteristics of type II diabetes smoker patients (n=576). Most of the patients were male (66.7%), having a mean age of 51.31 ± 13.76 years. Age distribution showed that 50.5% were between 18-50 years, and 49.5% were above 60 years old. BMI mean was 30.99 ± 5.20 kg/m2, with 9.2% categorized as normal, 38.0% as overweight, and 52.8% as obese. Mean DM duration was 6.53 ± 6.18 years, 58.9% having diabetes for 0-5 years and 41.1% for more than 5 years. Distribution of marital status was 29.2% were unmarried, 61.8% married and 9.0% separated, widowed, or divorced. Educational status distribution included 33.5% with primary education, 53.3% with secondary education, and 13.2% with higher education. In terms of residential status, 76.0% lived in urban areas, while 24.0% resided in rural areas. Occupational status indicated that 73.1% were employed, and 26.9% were unemployed.

Table II outlines the clinical characteristics of Type II diabetes smoker patients with or without hyperuricemia (n=576). The comparison with hyperuricemia revealed no significant differences in fasting blood glucose (p=0.637), random blood glucose (p=0.988), total cholesterol (p=0.229), triglyceride levels (p=0.997), HDL (p=0.114), LDL (p=0.482), SBP (p=0.871), and DBP (p=0.355). However, a significant difference was noted in uric acid levels, with those with hyperuricemia having a higher mean of 8.85 ± 0.66 compared to 6.03 ± 1.07 in the non-hyperuricemia group (p=0.000).

Table III presents factors associated with or without hyperuricemia among Type II diabetes smoker patients (n=576). The analysis includes age group, gender, BMI, hypertension, dyslipidemia, smoking status, waist circumference, total cholesterol, triglyceride, family history of hyperuricemia, HDL, and LDL. Among these factors, the odds ratios (OR) with 95% confidence intervals (C.I.) and p-values are provided. Notable findings include a significant association between hyperuricemia and smoking status (OR=1.6, p=0.672). Additionally, there is a trend toward association with hypertension (OR=1.42, p=0.058) and HDL levels (OR=1.88, p=0.132). No other variables showed significant correlations with hyperuricemia.

DISCUSSION

Diabetes mellitus (DM), also known as "sugar", is a chronic noncommunicable disease (NCD) that has emerged as a major global health concern. The condition is attributed to pancreatic insufficiency in insulin production, leading to elevated blood sugar levels known as hyperglycemia. Type 2 diabetes mellitus is associated with insulin resistance and inadequate

compensatory insulin secretion¹⁴.

Both young and elderly suffer from type 2 diabetes, which is closely linked to high rates of morbidity and death as well as significant medical expenses for affected individuals, their families, and nations¹⁵.

According to the International Diabetes Federation (IDF), there are 352 million persons worldwide who have impaired glucose tolerance, which raises their chances of developing diabetes by 2045. The burden of diabetes is rising, but there is a lack of

epidemiological data and inadequate therapies¹⁶.

The incidence of hyperuricemia has been increasing quickly in recent years among people worldwide¹⁵. Recent data indicates that hyperuricemia is becoming more common not only in

wealthy nations, but also frequently occurring in low- and middle-income nations. Obesity, a diet high in purines, and alcohol intake have all been shown as separate risk factors for the development of hyperuricemia¹⁷.

Hyperuricemia is very common in people with metabolic syndrome and has been linked to incident insulin resistance. Hyperuricemia is well recognised as a causative factor in the progression of diabetes, hypertension, atherosclerosis, cardiovascular disease, and chronic renal disease. 

As per our study findings, hyperuricemia was prevalent in 28.125% of patients. Several investigations were undertaken to determine the frequency of hyperuricemia in individuals with

type 2 diabetes mellitus (T2DM). The proportion of hyperuricemia between the cases of diabetes was 12.13% in Pakistan¹⁴, the incidence of Chinese cases was 32.6% with Type II diabetes mellitus¹⁵, prevalence rates of 33.6% and 25.3% have been seen in Indian individuals^16,17, Ethiopian cases 33.8% ¹⁸, and Nigerian cases 25.3%¹⁹. In terms of clinical practice, clinicians are becoming increasingly concerned about the prevalence of hyperuricemia with metabolic syndrome (MS). Moreover, hyperuricemia may not show symptoms until much later and may only be discovered in conjunction with other problems like uremia²⁰.

Most people agree that smoking cigarettes increases the chance of developing several well-known chronic illnesses including diabetes, cardiovascular disease, and cancer. Additionally, some chronic musculoskeletal conditions such degenerative disc disease, rheumatoid arthritis, and low back pain are thought to be linked to it. 

Hyperuricemia has lately gained attention due to research indicating its association with cardiovascular risk factors and its considerable contribution to the development of metabolic diseases.

The non-probability consecutive sampling limits the generalizability of the findings to the broader diabetic smoker population. The cross-sectional design prevents causal inferences between hyperuricemia and type 2 diabetes in smokers. Potential reporting biases may affect data accuracy, and the single-center setting restricts the applicability of the results to other populations or settings. Additionally, the sample may not fully represent the broader diabetic population with complex health conditions.

CONCLUSION

It is to be concluded that hyperuricemia is prevalent in type II diabetic smoker patients. Since the study was conducted on a limited sample size from a single hospital, the findings may not

accurately represent the situation across the entire country, and in order to generalize the results of our research, it must be assessed further in a broader sample of patients at other hospitals throughout the nation.

Conflict of Interest: Authors declare there is no conflict of interest.

Source of Fundings: Nil

Authors' Contributions: Kumar S: Led the study and was responsible for its overall design. Lata; Managed study logistics and assisted in data collection. Memon T: Handled data analysis and interpretation of results. Naveed: Conducted the literature review, contributed to manuscript writing, and provided a critical review. Each author played a crucial role in the successful completion of the research.

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How to cite: Kumar S, Lata, Memon TA, Naveed. Prevalence of Hyperuricemia in Smoker Population with Type 2 Diabetes Mellitus. Pak J Med Dent Sci. 2024;1(1):12-16