Serum Uric Acid Levels Improve Prediction of Incident Type 2 Diabetes in Individuals With Impaired Fasting Glucose: The Rancho Bernardo Study: Response to Oda and Kawai

Oda and Kawai (1) point out that uric acid (UA) levels may predict incident type 2 diabetes differently in men versus women. In our article (2), UA predicted type 2 diabetes independent of age, BMI, diuretic use, estimated glomerular filtration rate, and sex. Among 566 participants followed for 13 years, there were 55 new cases of type 2 diabetes (37 men and 18 women). Sex did not modify the association of UA with incident type 2 diabetes, although UA was higher in men (6.49 ± 1.23 mg/dl) than women (5.23 ± 1.15 mg/dl, P < 0.001). In response to the suggestion by Oda and Kawai, we performed a sex-stratified analysis adjusted for age, BMI, diuretic use, and estimated glomerular filtration rate. UA predicted incident type 2 diabetes in both sexes (odds ratio [95% CI] for men 1.36 [1.01–1.87], P = 0.04, and women 2.61 [1.54–4.44], P < 0.001). However, in an analysis further stratified by glucose tolerance status, UA predicted type 2 diabetes in women with isolated impaired fasting glucose (3.12 [1.01–9.9], P = 0.04) but not men (1.46 [0.82–2.6], P = 0.19). As stated in our original article (2), the small number of incident type 2 diabetes cases had insufficient power to exclude utility of UA prediction among impaired glucose tolerance and normoglycemic groups, and this was especially true in the sex-stratified analysis.