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A Multi-institutional Assessment of the Prevalence of Undiagnosed Diabetes Mellitus Among Uric Acid Stone Formers.
Scott V. Wiener, MD1, Natalia Hernandez, MD2, Brian Eisner, MD2, Vernon Pais, Jr., MD3, Carl Gjertson, MD1, Erica Lambert, MD1.
1University of Connecticut, Farmington, CT, USA, 2Massachusetts General Hospital, Boston, MA, USA, 3Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.

Background
The rate of uric acid stone formation has long been known to increase as a function of glucose control among diabetics and those with the metabolic syndrome. It is not known, however, if uric acid nephrolithiasis can also be a presenting sign of undiagnosed diabetes mellitus. In this multi-institutional pilot study, we seek to determine the prevalence of undiagnosed Diabetes and Pre-diabetes amongst uric acid stone formers.
Methods
Data from prospectively maintained clinical databases of stone formers were retrospectively acquired from 2008 onward by participating institutions. Patients forming >50% uric acid stones were identified and charts were assessed for a diagnosis of diabetes at the time of initial urologic encounter for stones. Those non-diabetic patients who underwent Hemoglobin A1c testing within 24 months form the study group. Patients were categorized as Pre-diabetic or Diabetic based upon an A1c value of 5.7-6.4 or >6.4 respectively.
Results
78 Uric acid stone formers were identified, of which 44 were non-diabetic and 34 diabetic. 21 non-dabetic patients underwent Hemoglobin A1c testing within 24 months of their stone event with a mean value of 9.3 months(0-19; 6.4 range; stdev). Age was 58 years(31-84; 13.4), BMI was 31 kg/m2 (21.4-45.7; 4.8) and A1c was 5.9%(4.6-7.5; 0.6). Of these, 12 (57%) were categorized as "Pre-diabetic" and 3 (14%) as "Diabetic" based upon A1c alone. Of this subgroup, 4 carried a diagnosis of gout; one was "Normal" and 3 were "Pre-Diabetic".
Conclusions
We identified a 71% rate of undiagnosed Pre-diabetes and Diabetes amongst a population of non-diabetic uric acid stone formers. Uric acid stone formation may be a harbinger of Diabetes Mellitus and further work is needed to determine if Hemoglobin A1c screening is appropriate in this population. The passage of a uric acid stone may be a critical opportunity for intervention and Diabetes prevention.


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