The relationships among hyperuricemia, body mass index and impaired renal function in type 2 diabetic patients

Elevated log uric acid-to-high-density lipoprotein cholesterol ratio (UHR) as a predictor of increased female infertility risk: insights from the NHANES 2013-2020

BACKGROUND

Infertility is a multifaceted condition influenced by metabolic and biochemical factors. Uric acid (UA) and high-density lipoprotein cholesterol (HDL-C) may individually affect reproductive health. The UA-to-HDL-C ratio (UHR), an emerging indicator of chronic inflammation and metabolic status, may be associated with infertility because of its connections to metabolic disorders, disrupted reproductive processes, and other related factors. Nevertheless, evidence of the relationship between the UHR and infertility remains limited and controversial. Therefore, potential associations were analyzed in this study.

METHODS

In this cross-sectional study, data from the 2013-2020 National Health and Nutrition Examination Survey (NHANES) were utilized, a nationally representative survey assessing the health and nutritional status of the U.S.

POPULATION

Female participants aged 18-45 years (n = 6502) whose infertility status was determined through self-reported responses to reproductive health questions were included. The primary outcome was infertility, defined on the basis of responses indicating difficulty in conceiving over the past year. Between-group differences were analyzed via Student's t test or the Mann‒Whitney U test for continuous variables or the chi-square test for categorical data. The independent association between infertility status and the log UHR was assessed by log computes logarithms by default natural logarithms. Subgroup analyses were performed to assess the strength of the results.

RESULTS

The mean log UHR of the women in the infertility group was significantly greater than that of the women in the noninfertility group (5.34 vs. 5.22, P < 0.001). Adjusted analyses revealed that an increase in the log UHR was associated with greater odds of infertility (odds ratio (OR) = 1.830, 95% confidence interval (CI) 1.396-2.401). Subgroup analysis revealed that women younger than 35 years with an elevated log UHR faced an even greater risk of infertility (OR = 2.716, 95% CI 1.784-4.162; P < 0.001).

CONCLUSIONS

An elevated UHR is associated with a higher risk of infertility, and this knowledge may be beneficial for developing a nonpharmacological intervention for improving fertility outcomes. Further research is needed to clarify the direct impact of the UHR on female infertility, which could inform future strategies for prevention and treatment.

A Phase 3, Multicenter, Randomized, Double-Blind, Placebo-Controlled 14-Week Study of Mirogabalin in Chinese Patients with Diabetic Peripheral Neuropathic Pain

INTRODUCTION

There is no approved effective drug for diabetic peripheral neuropathic pain (DPNP) in China. Gabapentinoids including mirogabalin have shown promise, although data in Chinese patients are scarce.

METHODS

This phase 3, multicenter, randomized, double-blind, placebo-controlled trial investigated the efficacy and safety of mirogabalin for treating DPNP in China. Mirogabalin was administered at 5 mg twice daily for the first week and uptitrated to 15 mg twice daily for a total duration of 14 weeks. The primary efficacy endpoint was the change from baseline in weekly average daily pain score (ADPS) at week 14; secondary endpoints included the ADPS responder rate, Short-Form McGill Pain Questionnaire visual analogue scale score, patient global impression of change (PGIC), average daily sleep interference score (ADSIS), EuroQol 5-dimensions 5-levels (EQ-5D-5L), and incidence of treatment-emergent adverse events (TEAEs).

RESULTS

Of 393 patients (mirogabalin, n = 196; placebo n = 197), the mean age was 58.2 years (mirogabalin, 58.7 years; placebo, 57.7 years) and 54.2% were male (mirogabalin, 56.1%; placebo, 52.3%). Mirogabalin elicited a greater change from baseline in the weekly ADPS vs. placebo at week 14: least-squares mean difference (95% confidence interval) vs. placebo - 0.39 (- 0.74, - 0.04), p = 0.0301. PGIC, ADSIS, and EQ-5D-5L data reflected significantly better improvements for patients receiving mirogabalin vs. placebo. The incidence of TEAEs was 75.0% and 75.1% in the mirogabalin and placebo groups, respectively. Most TEAEs were mild or moderate, and the incidence of TEAEs leading to treatment discontinuation was 2.6% in the mirogabalin group and 1.5% in the placebo group.

CONCLUSIONS

Although the effect size of mirogabalin was reduced due to the placebo effect, mirogabalin is a safe and effective treatment option for Chinese patients with DPNP.

TRIAL REGISTRATION

ClinicalTrials.gov identifier, NCT04094662.

Study on the Risk Factors for Hyperuricaemia and Related Vascular Complications in Patients with Type 2 Diabetes Mellitus

Purpose

The study aimed to identify diseases that exhibit significant differences between hyperuricaemia (HUA) and non-hyperuricaemia (NHUA) groups and analyse the risk factors for HUA based on the related diseases in type 2 diabetes mellitus (T2DM).

Methods

A total of 3264 T2DM patients were investigated from 2013 to 2017 in the Jinyang and Sanlin communities by obtaining basic data from the electronic medical record system (EMRS). From September 2018 to July 2019, 3000 patients (264 patients were missing during follow-up) were investigated with questionnaires, physical examinations and biochemical index tests. After removing missing values, 2899 patients were divided into HUA and NHUA groups. The chi-square test was used to identify diseases with differences. Using Lasso analysis and logistic regression analysis, risk factors for HUA based on the related diseases were obtained. The C-index, receiver operating characteristic (ROC) curve and calibration plot were used to validate the discrimination and accuracy of the factors.

Results

The chi-square test showed that there were significant differences in coronary heart disease (CHD) and diabetic nephropathy (DN) between the HUA group and the NHUA group. Through Lasso regression, glycosylated haemoglobin A1c (HbA1c), triglyceride (TG), blood urea nitrogen (BUN) and serum creatinine (SCR) were screened in the CHD group. Body mass index (BMI), HbA1c, total cholesterol (TC), TG, BUN, SCR and urine microalbumin (UMA) were screened in the DN group. The P-value of all the variables was less than 0.05. Through the C-index, calibration, and ROC curve analyses, these risk factors had medium accuracy.

Conclusion

HUA was significantly related to CHD and DN. The level of UA was correlated with HbA1c, TG, BUN, and SCR based on CHD. The level of UA was associated with BMI, HbA1c, TC, TG, BUN, SCR, and UMA based on DN.

Study on Risk Factors of Diabetic Nephropathy in Obese Patients with Type 2 Diabetes Mellitus

PURPOSE

The purpose of this study was to identify diabetic nephropathy risk factors in type 2 diabetes mellitus obese people based on community type 2 diabetes mellitus patients.

PATIENTS AND METHODS

In the community in Shanghai, we conduct a questionnaire, physical examination, and biochemical examination. The 406 patients included in the analysis were divided into two groups based on whether or not they had diabetic nephropathy. The influencing factors of type 2 diabetes mellitus obese patients were screened by the least absolute shrinkage and selection operator method, and then the influencing factors detected by the least absolute shrinkage and selection operator method were included in the binary logistic regression analysis, and the risk factors for diabetic nephropathy in obese people with type 2 diabetes mellitus were obtained. Finally, the nomogram and forest plot are used to visualize the binary logistic regression results, and the calibration plot and receiver-operating characteristic curve are used to verify the result.

RESULTS

The results showed that family history of diabetes (OR= 2.091, P= 0.002), disease course (OR=1.050, P= 0.007). hypertension (OR=1.768, P=0.042), hyperuricemia (OR=2.263, P=0.003), systolic blood pressure (OR=1.027, P<0.001), and glycosylated haemoglobin A1c (OR=1.358, P<0.001) were risk factors for diabetic nephropathy.

CONCLUSION

For obese patients with type 2 diabetes mellitus, they should pay attention to family history of diabetes, disease course and hyperuricemia. Hypertension should be concerned and strictly controlled. Systolic blood pressure and glycosylated haemoglobin A1c will help prolong the survival of diabetic nephropathy patients.