Diabetes mellitus, commonly known as diabetes, is a group of metabolic disease in which there are high blood sugar levels over a prolonged period of time. It is a group of disorders characterized by chronic hyperglycemia associated with disturbance of carbohydrate, protein and fat metabolism due to absolute or relative deficiency of insulin secretion or its action1. 2Identifying the risk factors for the development of diabetes is essential for its screening and prevention. For sometime it has been recognized that serum uric acid, an end product of purine metabolism is positively associated with serum glucose levels in healthy subjects with pre diabetes and early diabetes. The normal range for serum uric acid is 2.4 - 7.4 mg/dl in males and 1.4 - 5.8mg/dl in females. Furthermore, an elevated serum uric acid level was found to increase the chances of developing diabetes in individuals impaired with glucosetolerance2,3. Uric acid acts as a pro oxidant and thus it is a marker of oxidative stress, but it may also have a therapeutic role as an antioxidant. Urate, the soluble form of uric acid, can scavenge the superoxide and the hydroxyl radicals and it can chelate the transition metals. Hyperuricaemia has been also added to the set of metabolic abnormalities which are associated with insulin resistance and / or hyperinsulinaemia in the metabolic syndrome. Hypouricaemia has also been implicated in the development of diabetic nephropathy3,4. Several studies had shown that the role of uric acid in the development of diabetes is controversial. Therefore this review was done to relate how serum uric acid level is associatedwith the risk of diabetes. Diabetes Diabetes mellitus, commonly called as diabetes, is a disorder in which one’s body does not make enough insulin or not able to use normal amount of insulin properly. Insulin is a hormone that regulates the amount of sugar in blood. High blood sugar level will cause problems in many parts of our body5. Types of Diabetes Type 1 diabetes Type 1 diabetes generally occurs in children. It is also called juvenile onset diabetes mellitus or insulin-dependent diabetes mellitus. In this type, our pancreas will not be able to make enough insulin and the person has to take insulin injections for the rest of life6. Type 2 diabetes Type 2 diabetes, which is more common, usually occurs in people over 40 years of age and is called adult onset diabetes mellitus. It is also called non-insulin-dependent diabetes mellitus. In Type 2, pancreas makes insulin, but body doesn’t use it properly. The high blood sugar level is often controlled by following a proper diet and/or taking medication, although some patients must take insulin. Type 2 diabetes is particularly more prevalent among Africans, Indians, Latins and Asians6,7. Uric Acid Uric acid is a heterocyclic compound of carbon, hydrogen, nitrogen and oxygen, with the formula C5H4N4O3. It forms salts and ions known as urates and acid urates, such as ammonium acid urate. Uric acid is the final product obtained by the metabolic breakdown of purine nucleotides. High blood concentrations of uric acid can lead to gout and are associated with other medical conditions including diabetes and the formation of ammonium acid urate kidney stones. Uric acid is the waste product that is normally found in the blood. High amounts of uric acid in the blood can cause crystal formation in the joints, leading to the condition gout. However, only a small portion of people with high uric acid levels are possibly to get gout. Researches have shown that there are strong links between the uric acid levels and metabolic syndrome. Studies in people with pre-diabetes and among elderly people have suggested that high uric acid levels raise a person’s chances of getting diabetes8,9. Uric Acid and Type 2 Diabetes People who had higher uric acid levels are more likely to get type 2 diabetes. Uric acid is measured as milligrams per deciliter. For every 1 milligram per deciliter increase in uric acid, the risk of type 2 diabetes is increased by 20 percent in elderly people and by 15 percent in their children10-12. Hyperuricemia Hyperuricemia is condition with increased uric acid levels in the body. It is common in elderly, male patients. Associated diseases and renal impairment can be found frequently13. It has been seen that hyperuricemia is commonly associated with obesity, hypertriglyceridemia, diabetes mellitus, development and progression of coronary artery disease14,15 and hypertension16. Serum Uric Acid is as independent risk factor for development and progression of Coronary Artery Disease. Marked hyperuricemia is known to cause acute renal failure via intra renal crystal deposition1 Hyperuricemia is associated with renal disease, but it is usually considered a marker of renal dysfunction rather than a risk factor for progression. Recent studies have reported that mild hyperuricemia in normal rats induced by the uricase inhibitor, oxonic acid (OA), results in hypertension, intrarenal vascular disease, and renal injury. This led to the hypothesis that uric acid may be a true mediator of renal disease and progression18. Male gender is associated with a more rapid progression of renal disease independent of blood pressure, dietary protein intake, or serum lipid levels. Although hyperuricemia has long been associated with renal disease, uric acid has not been considered as a true mediator of progression of renal Disease. The observation that hyperuricemia is commonly associated with other risk factors of cardiovascular and renal disease, especially hypertension, has made it difficult to dissect the effect of uric acid itself. However, recent epidemiologic evidence suggests a significant and independent association between the level of serum uric acid and renal disease progression with beneficial effect of decreasing uric acid levels. Furthermore, our experimental data using hyperuricemic animals and cultured cells have provided robust evidence regarding the role of uric acid on progression of renal disease. Recent data also suggest hyperuricemia may be one of the key and previously unknown mechanisms for the activation of the renin-angiotensin and cyclooxygenase-2 (COX-2) systems in progressive renal disease. Although we must be cautious in the interpretation of animal models to human disease, these studies provide a mechanism to explain epidemiologic data that show uric acid is an independent risk factor for renal progression. Although there is no concrete evidence yet that uric acid bears a causal or reversible relationship to progressive renal disease in humans, it is time to reevaluate the implication of hyperuricemia as an important player for progression of renal disease and to try y to find safe and reasonable therapeutic modalities in individual patients based on their clinical data, medication history, and the presence of cardiovascular complications19-21. Hyperuricemia is commonly associated with traditional risk factors such as abnormalities in glucose metabolism, dyslipidemia and hypertension.

Ethical clearance was obtained from Institute’s ethical clearance committee. Informed consent was taken from both cases and controls after explaining the procedure. 45 cases of DM and 45 healthy controls were included. Fasting and postprandial blood sugar levels were estimated by using the glucose oxidase-peroxidase (GOD/POD) method. Serum lipid profile, Blood urea estimation was done manually by using the diacetyl monoxime method (DAM). Serum creatinine estimation was done by using the alkaline picrate method. Blood samples were centrifuged and serum uric acid levels (Reference range Male – 3.0 to 7.0 mg/dl & Female – 2.0 to 6.0 mg/dl) are analyzed by uricase method using Biosystems auto analyzer on the same day of collection. Inclusion criteria: Patients with type 2 diabetes mellitus (irrespective of their glycemic status and duration of diabetes), Patient’s age > 40 years, both sexes were included. Exclusion criteria: Renal failure, on long term diuretics and steroids, Regularly consuming alcohol, On antimetabolite and chemotherapy drugs, Hepatic disorders. Peripheral vascular disease/ cerebrovascular disease/ pulmonary tuberculosis, renal transplant patients, Pregnancy and lactating mothers. Statistical analysis :Data was expressed in terms of mean ± SD. Chi- square test was applied to estimate the difference between the two groups of population. Unpaired‘t’-test was used to study the changes in serum magnesium and zinc in between cases and controls. Pearson correlation was performed to establish the relationship between study variables. p value <0.05 was considered statistically significant.

Mean and standard deviation for the age of the cases and controls were 59.55±8.69 and 55.8 ±8.96 respectively; there was no significant difference among the cases and controls concerning the age. The distribution of cases and controls about age showed *p= 0.058 (not significant). The age group of the case and control group did not vary significantly. Among the 70 cases studied, there were 42 males and 28 females. Among 30 controls, there were 16 males and 14 females with *P= 0.6986 (not significant). The sex composition of the study and control group did not differ significantly (Table – 1). Table 1 Mean age of cases and controls Cases Controls P value Mean age 59.55±8.69 55.8 ±8.96 0.058 The mean and standard deviation for the cases and controls were 24.38±2.8 and 22.07±2.23 respectively. The BMI of the study group was significantly higher than that of the control group (p = 0.0028) as per Table – 2. There was no significant difference between cases and controls about selected cardiovascular risk factors. Table 2 mean serum uric acid and BMI Cases Controls P value BMI 24.38 22.07 0.0028 Serum uric acid 5.26±1.39 3.54±0.62. 0.001 Mean serum uric acid in the study population was 5.26±1.39. Mean serum uric acid in the control group was 3.54±0.62. The serum uric acid levels in diabetics were very much high when compared with controls and it was highly significant. The mean serum uric acid value in males was 5.45±1.47 whereas in females it was 4.97±1.23.In the study group mean serum uric acid values were higher in males than in females but the difference was not statistically significant. Hyperuricemia is defined as serum uric acid level ≥7 mg/dl in males and ≥6.5 mg/ dl in females p =0.0001 (significant) as per Table-2

In present study, we evaluated the association of serum uric acid with blood sugar levels. Maximum cases (32.2%) belonged to age group 61-70 years followed by age group 51-60 years (27.8%). Similar results were observed by the study done by various authors (Sirsath et al.9 and Behradmanesh S et al.10) In present study, males (56.7%) out numbered the females (43.3%). Study done by Prashant et al.11 and Prabhuswamy et al.12 also observed male predominance over females in their studies. In present study, Majority of subjects (78.9%) and 73.3% had high fasting and postprandial blood sugar levels respectively. The results of present study are in accordance with study done by sirsath et al. Study done by Talwar et al.13 had higher mean FBS in comparison of present study. The uric acid of majority number of present study participant females (80.39%) had level of ≥ 6.3, rest (19.61%) had levels of 2.1–6.3. Future experimental studies are needed to establish the underlying mechanisms of the present cross-sectional study results. Limitations of the study : Small number of the sample

Serum uric acid levels were significantly elevated in the diabetic population. The serum uric acid level was independent of age and smoking status (in males). Mean serum uric acid levels were high in males. Serum uric acid levels increased with increasing duration of diabetes. Serum uric acid levels in diabetic patients with CAD were significantly higher. Serum uric acid above 4 mg/dl in the diabetic population is a marker or risk factor for CAD. Diabetic patients with raised serum uric acid levels should be carefully monitored for CAD as well as other vascular episodes. Meticulous control of blood sugar, hypertension, dyslipidemia, body weight, and abdominal girth form an essential component of diabetes which will bring down uric acid levels. It is worth to explore uric acid levels in diabetic patients with other cardiovascular risk factors like obesity, dyslipidemia, hypertension to detect early cardiovascular complications. Future study:Further studies on these parameters on large scale is required to establish diagnosic and prognostic role of these parameters in Diabetes mellitus. Acknowledgement : I would like to thank my teachers, my family for their constant guidance and support throughout the study. Source of support : Nil.

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