title: Lowering Uric Acid With Allopurinol Improves Insulin Resistance and Systemic Inflammation in Asymptomatic Hyperuricemia.
abstract: BACKGROUND
  Hyperuricemia is an independent predictor of impaired fasting glucose and type 2 diabetes, but whether it has a causal role in insulin resistance remains controversial. Here we tested the hypothesis that lowering uric acid in hyperuricemic nondiabetic subjects might improve insulin resistance.
  
  
  METHODS
  Subjects with asymptomatic hyperuricemia (n = 73) were prospectively placed on allopurinol (n = 40) or control (n = 33) for 3 months. An additional control group consisted of 48 normouricemic subjects. Serum uric acid, fasting glucose, fasting insulin, HOMA-IR (homeostatic model assessment of insulin resistance), and high-sensitivity C-reactive protein were measured at baseline and at 3 months.
  
  
  RESULTS
  Allopurinol-treated subjects showed a reduction in serum uric acid in association with improvement in fasting blood glucose, fasting insulin, and HOMA-IR index, as well as a reduction in serum high-sensitivity C-reactive protein. The number of subjects with impaired fasting glucose significantly decreased in the allopurinol group at 3 months compared with baseline (n = 8 [20%] vs n = 30 [75%], 3 months vs baseline, P < 0.001). In the hyperuricemic control group, only glucose decreased significantly and, in the normouricemic control, no end point changed.
  
  
  CONCLUSIONS
  Allopurinol lowers uric acid and improves insulin resistance and systemic inflammation in asymptomatic hyperuricemia. Larger clinical trials are recommended to determine if lowering uric acid can help prevent type 2 diabetes.
authors.affiliation: From the *Department of Medicine, Division of Endocrinology, †Department of Medicine, ‡Department of Medicine, Division of Nephrology, and §Departments of Biochemistry and ¶Family Medicine, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul; and ∥Department of Medicine, Division of Nephrology, Konya Numune State Hospital, Konya, Turkey; **Division of Renal Diseases and Hypertension, University of Colorado, Denver, CO; and ††Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey.
authors.forename: Mumtaz
authors.initials: M
authors.lastname: Takir
authors.forename: Osman
authors.initials: O
authors.lastname: Kostek
authors.forename: Abdullah
authors.initials: A
authors.lastname: Ozkok
authors.forename: Omer Celal
authors.initials: OC
authors.lastname: Elcioglu
authors.forename: Ali
authors.initials: A
authors.lastname: Bakan
authors.forename: Aybala
authors.initials: A
authors.lastname: Erek
authors.forename: Hasan Huseyin
authors.initials: HH
authors.lastname: Mutlu
authors.forename: Ozge
authors.initials: O
authors.lastname: Telci
authors.forename: Aysun
authors.initials: A
authors.lastname: Semerci
authors.forename: Ali Riza
authors.initials: AR
authors.lastname: Odabas
authors.forename: Baris
authors.initials: B
authors.lastname: Afsar
authors.forename: Gerard
authors.initials: G
authors.lastname: Smits
authors.forename: Miguel
authors.initials: M
authors.lastname: ALanaspa
authors.forename: Shailendra
authors.initials: S
authors.lastname: Sharma
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Johnson
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kanbay
mesh_terms: D000328:Adult; D000368:Aged; D000493:Allopurinol / Q000627:therapeutic use*; D058070:Asymptomatic Diseases / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D033461:Hyperuricemia / Q000097:blood* / Q000188:drug therapy*; D007249:Inflammation / Q000097:blood / Q000188:drug therapy; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014527:Uric Acid / Q000097:blood*
chemical_list: D015415:Biomarkers; D014527:Uric Acid; D000493:Allopurinol