Hyperurichemia and diabetes mellitus
I.V. Madyanov
The Postgraduating Doctors’ Training Institute, Cheboksary
The article is devoted to the analysis of the relationship between hyperuricemia (HU) and diabetes mellitus (DM). In the experiment, HU detects diabetogenic properties and contributes to the development and progression of DM. In the population sample, HU is associated with metabolic syndrome and its components. Its presence increases the risk of impaired tolerance to glucose and type 2 DM 4 times. Hyperglycemia and glucosuria increase uric acid excretion through the kidneys, so the development of HU in DM is very closely related to kidney damage. Decrease in renal excretion of urates in HU is recorded in 95.7% of patients with type 1 DM and 68.9% of patients with type 2 DM. In case of type 1 DM, the development of HU is mainly due to low nodule filtration of uric acid, whereas in case of type 2 DM, the suppression of urate channel secretion is of primary importance. HU is able to have a damaging effect on kidneys, which dictates the need for its active medical correction. The lecture provides a comparative assessment of allopurinol and febuxostat in case of uratinizing therapy in patients with DM.
Despite all the advantages of febuxostat, considering its relatively higher cost compared to allopurinol, its administration is justified in case of allopurinol intolerance and/or renal failure, which limits the use of allopurinol in the effective dose.
HU is significant at all stages of development and progression of diabetes mellitus. In the population sample, it indicates the risk of DM development, in clinical forms it indicates metabolic failure and renal damage. At the same time, HU has a pathogenic effect on the insular apparatus of the pancreas, kidneys and vessels. Therefore, its correction with xanthioxidase inhibitors of allopurinol or febuxostate in DM appears to be pathogenetically justified and has a positive effect on purine, carbohydrate and lipid metabolism, as well as lipid peroxidation processes.
Keywords: diabetes mellitus, hyperuricemia, uric acid, kidney damage, urate-lowering therapy, allopurinol, febuxostat.
For citation: Madyanov I.V. Hyperurichemia and diabetes mellitus. RMJ. Medical Review. 2019;1(I):20–24.
References
1. Елисеев М.С. Хроническая болезнь почек: роль гиперурикемии и возможности уратснижаюшей терапии. Современная ревматология. 2018;1:60–65 [Yeliseyev M.S. Chronic kidney disease: the role of hyperuricemia and the possibility of lowering therapies. Modern rheumatology. 2018;1:60–65 (in Russ.)].
2. Мадянов И.В., Балаболкин М.И., Григорьев А.А. Экспериментальная оценка диабетогенных эффектов мочевой кислоты. Проблемы эндокринологии. 1997;1:36–38 [Madyanov I.V., Balabolkin M.I., Grigoriev A.A. Experimental evaluation of diabetic effects of uric acid. Endocrinology problems. 1997;1:36–38 (in Russ.)].
3. Мадянов И.В. Особенности пуринового обмена на этапах развития и прогрессирования сахарного диабета (диагностические, патогенетические и лечебные аспекты): автореф. дис. … докт. мед. наук. М., 1999. [Madyanov I.V. Features of purine metabolism at the stages of development and progression of diabetes mellitus (diagnostic, pathogenetic and therapeutic aspects): thesis. M.; 1999 (in Russ.)].
4. Мадянов И.В. Мочевая кислота и сахарный диабет. Промежуточные итоги многолетних исследований. Здравоохранение Чувашии. 2017;2:59–64 [Madyanov I.V. Uric acid and diabetes. Intermediate results of years of research. Health care Chuvashia. 2017;2:59–64 (in Russ.)].
5. Мясоедова С.Е. Новые возможности уратснижающей терапии при подагре. Трудный пациент. 2018;3:28–31 [Myasoedova S.E. New features of uratic therapy for gout. Difficult patient. 2018;3:28–31 (in Russ.)].
6. Цурко В.В., Морозова Т.Е. Подагра, гиперурикемия и сердечно-сосудистые заболевания. Подходы к фармакотерапии. Лечащий врач. 2018;8:52–55 [Tsurko V.V., Morozova T.E. Gout, hyperuricemia, and cardiovascular diseases. Approaches to pharmacotherapy. Attending doctor. 2018;8:52–55 (in Russ.)].
7. Ito H., Antoku S., Abe M. et al. Comparison of the Renoprotective Effect of Febuxostat for the Treatment of Hyperuricemia between Patients with and without Type 2 Diabetes Mellitus: A Retrospective Observational Study. Intern Med. 2016;55(22):3247–3256.
8. Kushiyama A., Tanaka K., Hara S., Kawazu S. Linking uric acid metabolism to diabetic complications . World J Diabetes. 2014;5(6):787–795.
9. Vargas-Santos A.B., Peloquin C.E., Zhang Y., Neogi T. Association of Chronic Kidney Disease With Allopurinol Use in Gout Treatment. JAMA Intern Med. 2018;178(11):1526–1533.
2. Мадянов И.В., Балаболкин М.И., Григорьев А.А. Экспериментальная оценка диабетогенных эффектов мочевой кислоты. Проблемы эндокринологии. 1997;1:36–38 [Madyanov I.V., Balabolkin M.I., Grigoriev A.A. Experimental evaluation of diabetic effects of uric acid. Endocrinology problems. 1997;1:36–38 (in Russ.)].
3. Мадянов И.В. Особенности пуринового обмена на этапах развития и прогрессирования сахарного диабета (диагностические, патогенетические и лечебные аспекты): автореф. дис. … докт. мед. наук. М., 1999. [Madyanov I.V. Features of purine metabolism at the stages of development and progression of diabetes mellitus (diagnostic, pathogenetic and therapeutic aspects): thesis. M.; 1999 (in Russ.)].
4. Мадянов И.В. Мочевая кислота и сахарный диабет. Промежуточные итоги многолетних исследований. Здравоохранение Чувашии. 2017;2:59–64 [Madyanov I.V. Uric acid and diabetes. Intermediate results of years of research. Health care Chuvashia. 2017;2:59–64 (in Russ.)].
5. Мясоедова С.Е. Новые возможности уратснижающей терапии при подагре. Трудный пациент. 2018;3:28–31 [Myasoedova S.E. New features of uratic therapy for gout. Difficult patient. 2018;3:28–31 (in Russ.)].
6. Цурко В.В., Морозова Т.Е. Подагра, гиперурикемия и сердечно-сосудистые заболевания. Подходы к фармакотерапии. Лечащий врач. 2018;8:52–55 [Tsurko V.V., Morozova T.E. Gout, hyperuricemia, and cardiovascular diseases. Approaches to pharmacotherapy. Attending doctor. 2018;8:52–55 (in Russ.)].
7. Ito H., Antoku S., Abe M. et al. Comparison of the Renoprotective Effect of Febuxostat for the Treatment of Hyperuricemia between Patients with and without Type 2 Diabetes Mellitus: A Retrospective Observational Study. Intern Med. 2016;55(22):3247–3256.
8. Kushiyama A., Tanaka K., Hara S., Kawazu S. Linking uric acid metabolism to diabetic complications . World J Diabetes. 2014;5(6):787–795.
9. Vargas-Santos A.B., Peloquin C.E., Zhang Y., Neogi T. Association of Chronic Kidney Disease With Allopurinol Use in Gout Treatment. JAMA Intern Med. 2018;178(11):1526–1533.
This work is licensed under a Creative Commons «Attribution» 4.0 License.
Previous article
Next article
Распечатать