Interactions among endotoxin, uric acid, and lactate in relation to the risk of type 2 diabetes: A population-based study

Background Blood levels of endotoxin, uric acid (UA), or lactate (LAC) are associated with type 2 diabetes mellitus (T2DM). Thus, we explored the interactions among blood endotoxin, UA, and LAC levels and the risk of T2DM. Methods This population-based cross-sectional study included 2520 Chinese adults. Fasting blood endotoxin, UA, and LAC levels were determined and the cut-off values were obtained from the receiver operating characteristic curve analysis. The study population was classified into two or four subgroups based on low or high, or both low and high levels of endotoxin, UA, and LAC, respectively. Results The odds ratios (ORs) for T2DM (all P < .05) were higher in the high groups than the low groups of endotoxin, UA, or LAC, respectively. Participants in the groups with high levels of both endotoxin and UA, endotoxin and LAC, or UA and LAC, had 4.71 (95% CI 3.01-7.37), 5.13 (95% CI 3.29-7.99), or 3.73 (95% CI 2.34-5.94) times higher risk for T2DM compared to those in groups with low levels of both endotoxin and UA, endotoxin and LAC, or UA and LAC (all P < 0.05), respectively. In the interaction analysis, an interactive effect between endotoxin and UA (P < .05), or endotoxin and LAC (P < .05), but not UA and LAC, was observed that contributed to an increased risk of T2DM. Conclusions The interaction between levels of endotoxin and UA or levels of endotoxin and LAC was related to an increased risk of T2DM in the Chinese population. Highlights Blood levels of endotoxin, uric acid (UA), or lactate (LAC) were associated with systemic inflammation, insulin resistance, and risk of type 2 diabetes mellitus (T2DM). The interaction between levels of endotoxin and UA or levels of endotoxin and LAC was related to an increased systemic inflammation, insulin resistance, and T2DM.