Retinol Binding Protein 4 and Uric Acid as Risk Factors for Insulin Resistance in Type 2 Diabetes Mellitus.

Abstract

Background: Hyperuricemia (HUA) is closely associated with insulin resistance (IR). Retinol-binding protein 4 (RBP4) plays a critical role in inducing IR. However, the combined effects of uric acid (UA) and RBP4 on IR remain unclear. This study aimed to identify the risk factors for IR in type 2 diabetes mellitus (T2DM) patients and to investigate the potential relationship between UA and RBP4 in this context.

Methods: This study included 570 patients aged 18-60 years with T2DM who were treated at Taizhou Hospital in Zhejiang Province. Univariate and multivariate logistic regression analyses were performed to evaluate the associations of UA and RBP4 levels with IR risk in T2DM patients. Mediation analysis was conducted to assess the mediating role of RBP4 in the relationship between UA and homeostasis model assessment of insulin resistance (HOMA-IR). Finally, ROC curve analysis was performed to examine the evaluation value of the model for IR in patients with T2DM.

Results: RBP4 and UA levels were significantly correlated with HOMA-IR (p < 0.01). Mediation analysis revealed that RBP4 partially mediated the relationship between UA and IR (p < 0.05, with the mediating effect accounting for 23.2%). Furthermore, both RBP4 and UA were identified as significant risk factors for IR in patients with T2DM (p < 0.05). The risk of IR associated with HUA was greater when RBP4 ≥ 36.6 mg/L (p < 0.001). The ROC analysis showed that compared with UA or RBP4 alone, the combination of RBP4 and UA was more effective in detecting IR and represented a superior assessment model (AUC = 0.788, p < 0.001).

Conclusions: RBP4 played a partial mediating role between UA and IR. Both RBP4 and UA were risk factors for IR in T2DM patients. The combined use of these two indicators can better evaluate the risk of IR. Further research is needed to validate the reliability of using UA and RBP4 levels to evaluate IR.