Exploring Uric Acid to HDL Ratio as a Long‐Term Biomarker for Diabetes Mellitus

BACKGROUND Diabetes mellitus (DM) poses a major challenge to public health worldwide. The ratio of serum uric acid to high-density lipoprotein cholesterol (UHR) has recently emerged as a promising indicator of inflammation linked to a range of cardio-metabolic conditions. However, its association with DM is not fully clear.

METHODS Data from 7617 individuals aged 35-65 enrolled in the Mashhad stroke and heart atherosclerotic disorder (MASHAD) cohort were followed for a decade to explore the link between UHR and diabetes onset. Logistic regression, adjusted for confounders, evaluated the association. Restricted cubic spline models captured nonlinear trends, while receiver operating characteristic (ROC) analysis identified gender-specific thresholds. All statistical procedures were performed using SPSS (v26).

RESULTS Elevated levels of the UHR were significantly linked to a higher risk of developing DM. In the fully adjusted model, each incremental rise in UHR was associated with an odds ratio (OR) of 1.07 (95% CI [1.05-1.08], p < 0.001). Subgroup analyses also indicated consistent predictive capability across genders, and ROC analysis revealed optimal UHR thresholds of 12.74 for men (sensitivity 72.17%, specificity 47.79%, area under the curve (AUC) 0.6188) and 9.88 for women (sensitivity 59.46%, specificity 61.61%, AUC 0.6357).

CONCLUSION The UHR is a remarkable predictor of DM incidence over a decade-long follow-up, highlighting its potential as an early biomarker for diabetes risk assessment in clinical settings. Additional studies are needed to clarify the biological pathways linking UHR to diabetes development and to assess whether modifying this ratio could help lower disease risk.