Association between uric acid to HDL cholesterol ratio and HbA1c in type 2 diabetes mellitus: a novel biomarker of glycemic control

Abstract Objective The uric acid–to–high-density lipoprotein cholesterol ratio (UHR) has emerged as a potential metabolic marker reflecting insulin resistance and metabolic imbalance. However, evidence regarding its association with glycemic control in type 2 diabetes mellitus (T2DM) remains limited. This study aimed to evaluate the relationship between UHR and glycemic control in patients with T2DM and to investigate whether this association differs by gender. Methods This cross-sectional study included 216 participants, comprising 161 patients with T2DM and 55 healthy controls. Patients with T2DM were categorized as well-controlled (HbA1c < 7%) or poorly controlled (HbA1c ≥ 7%). UHR was calculated as the ratio of serum uric acid to HDL cholesterol. Group comparisons, correlation analyses, and hierarchical logistic regression models were performed. Analyses were adjusted for gender, age, body mass index (BMI), and estimated glomerular filtration rate (eGFR). Gender-stratified analyses were conducted to evaluate sex-specific associations. Results UHR levels were significantly higher in patients with T2DM compared with controls ( p < 0.001). UHR showed significant positive correlations with HbA1c ( r = 0.288, p < 0.001) and fasting plasma glucose ( r = 0.332, p < 0.001). In hierarchical logistic regression analyses, UHR remained independently associated with poor glycemic control after full adjustment (OR = 1.297, 95% CI: 1.186–1.436, p < 0.001). Receiver operating characteristic analysis showed moderate discriminative performance of UHR for identifying poorly controlled diabetes (AUC = 0.762, 95% CI: 0.698–0.827, p < 0.001). In gender-stratified analyses, UHR was significantly higher in diabetic women ( p < 0.001) and diabetic men ( p = 0.002) compared with controls, whereas direct comparisons between sexes did not reveal a significant difference. Conclusion UHR is independently associated with poor glycemic control in patients with T2DM, with consistent findings across both genders. As a simple and accessible biomarker reflecting metabolic imbalance, UHR may help identify patients at risk of inadequate glycemic control. Prospective studies are needed to clarify its predictive value in diabetes management.