1. Introduction
Diabetes mellitus is characterized by hyperglycemia and impaired metabolism of carbohydrates, fats, and proteins, and is associated with an absolute or relative lack of insulin [1]. This disease is one of the most common chronic diseases in the world whose prevalence is increasing due to lifestyle changes and improvement in the health status of communities [2, 3]. This prevalence is higher in urban areas (10.8%) than in rural areas (7.2%), and in high-income countries (10.4%) than in low-income countries (4%). One in two individuals with diabetes (50.1%) is unaware of their disease. The global prevalence of glucose intolerance in 2019 was at 7.5% (374 million), and is estimated to reach 8% (454 million) by 2030, and 8.6% (548 million) by 2045 [4]. Type 2 Diabetes (T2D) is the fourth leading cause of death in developed countries, and currently five million people in Iran have diabetes with a rising trend [5]. The T2D is associated with a range of metabolic disorders such as obesity, hypertension, high cholesterol, high Triglycerides (TG), hyperuricemia, and insulin resistance [6, 7]. Many studies have shown the association of Uric Acid (UA) with metabolic syndrome, insulin resistance, and T2D [8]. This study aims to evaluate the UA level and glycemic status of patients with T2D.
2. Methods
In this cross-sectional study, participants were 230 patients with T2D referred to Razi Hospital and Besat clinic in Rashti, Iran in 2020. Those with urinary tract infection, fever, congestive heart failure, history of diuretic use, UA-lowering drugs, pregnancy, breastfeeding, acute renal failure, and alcohol consumption were excluded from the study. All individuals were willing to participate in the study and signed a written informed consent form. A researcher-made checklist were used to collect demographic and clinical information which had three main sections. The first section surveys demographic characteristics such as age, gender, disease duration, and Body Mass Index (BMI). The second section surveys laboratory test results of Fasting Blood Sugar (FBS), Hemoglobin A1C (HbA1c), cholesterol, TG, High Density Lipid (HDL), Low Density Lipid (LDL), UA, and Creatinine (Cr). The third section surveys the history of heart disease, blood pressure, and smoking. The results were analyzed in SPSS v. 26 software (IBM, USA).
3. Results
 Of 230 participants, 160 (69.6%) were female and the rest were male with a mean age of 57.36±8.05 years. The mean systolic and diastolic blood pressure levels were 134.65±16.52, and 80.22±10.63, respectively. The mean duration of diabetes was 11.63±7.21 years, ranging from one month to 30 years. The mean BMI was 28.1±4.62 kg/m2, ranging from 19 to 44 kg/m2. Furthermore, 43 (18.7%) had a history of smoking, 67% had a history of hypertension, and 24.8% had a history of heart disease.  As shown in Table 1, the UA level had a significant relationship with the levels of HbA1C (r=0.318, P<0.001), Cr (r=0.351, P<0.001) and TG (r=0.174, P=0.008).


The variables of age, gender, BMI, smoking, HbA1c level, and Cr level significantly affect the UA level in patients. There was no significant relationship between thee levels of FBS and UA.
4. Conclusion
The purpose of this study was to evaluate the UA level and glycemic control in T2D patients. The demographic, clinical and laboratory factors that may be related to UA levels including age, gender, MBI, blood pressure, and duration of diabetes were evaluated. The results showed a between the UA level and increased levels of HbA1c, Cr, and TG. Moreover, gender, aging, MBI, and smoking showed a significant positive relationship with the UA level. The results of a study showed that UA plays an important role in the development of renal dysfunction independent of the effects of hypertension [9]. People with elevated serum UA level are at a higher risk of developing kidney failure than people with normal UA level [10]. The progression of diabetic nephropathy is faster in patients with higher serum UA levels [11]. In overall, in T2D patients, serum UA level has an adverse effect on glycemic status.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the research ethics committee of Guilan University of Medical Sciences (Code: IR.GUMS.REC.1399.171). Ethical principles are fully observed in this article. 

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors' contributions
Design of study, initial draft preparation and data analysis: Maryam Yaseri; Supervision and data collection: Haniyeh Sadat Fayazi; Initial draft preparation and data analysis: Seyyedeh Sahereh Mortazavi; Initial draft preparation and editing: Niloofar Faraji.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors would like to thank all patients and the staff of Razi Hospital and Besat clinic for their cooperation in this study.


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