# Serum uric acid to HDL-Chol ratio (UHR) is associated with insulin resistance/sensitivity in individuals without diabetes

## TL;DR

The study shows that the uric acid to HDL cholesterol ratio is linked to insulin resistance in people without diabetes, suggesting it could be a useful and simple tool for early metabolic risk detection.

## Contribution

The study demonstrates UHR's association with insulin resistance in non-diabetic individuals, offering a new, accessible metabolic risk marker.

## Key findings

- UHR positively correlates with markers of insulin resistance like HOMA-IR and fasting insulin.
- UHR negatively correlates with insulin sensitivity measures like the Matsuda index and Clamp M.
- UHR is a promising, low-cost indicator for metabolic risk in individuals without diabetes.

## Abstract

The uric acid-to-HDL cholesterol ratio (UHR) is a promising non-insulin-based marker for metabolic risk, associated with type 2 diabetes, hypertension, hepatic steatosis, and cardiovascular disease. However, its utility in individuals with altered glucose tolerance remains unclear.

We investigated the relationship between UHR and insulin sensitivity in two independent cohorts. Sample 1 (n = 1555) from the CATAMERI study, was stratified based on oral glucose tolerance test (OGTT) results, and Sample 2 (n = 332) from the EUGENE2 project, with insulin sensitivity measured via euglycemic-hyperinsulinemic clamp.

In Sample 1, UHR showed positive correlations with BMI, triglycerides, 2-hour plasma glucose, HOMA-IR, fasting plasma insulin (p < 0.0001 for all) and with HbA1c (p < 0.001), and negative correlations with Matsuda index (p < 0.0001) and total cholesterol (p = 0.019). Multivariable linear regression identified HOMA-IR (β = 0.100), Matsuda index (β=-0.146), InsAUC30/GluAUC30 (β = 0.120), and Stumvoll 1st-phase insulin secretion (β = 0.121) as independent UHR predictors. In Sample 2, bivariate analyses, adjusted for age, sex, and BMI, confirmed positive correlations between UHR and HbA1c (p < 0.001), 2-hour post-load glucose (p = 0.001), BMI, triglycerides, and fasting insulin (p < 0.0001 for all) and a negative correlation with Clamp M (glucose disposal, p = 0.0003). Finally, multivariable regression of Clamp M variability (adjusted for age, sex, and BMI) demonstrated significant negative associations with UHR (β= -0.230) and BMI (β= -0.375).

These findings suggest that UHR, derived easily and inexpensively from routine clinical measurements, is a promising indicator of metabolic risk in individuals without diabetes. Its accessibility positions it as a potential tool for early diabetes prevention strategies, potentially reducing reliance on the OGTT.

The online version contains supplementary material available at 10.1007/s00592-025-02576-2.