Association of Hyperuricemia with the Onset and Progression of Type 2 Diabetic Retinopathy

Background/Objectives: The relationship between hyperuricemia and diabetic retinopathy (DR) remains controversial despite both conditions being associated with vascular endothelial dysfunction. This study aimed to investigate the longitudinal association between hyperuricemia and the onset and progression of DR in patients with type 2 diabetes mellitus (T2D). Methods: We conducted a retrospective cohort study using patient data from initial visits between 2005 and 2022. Patients were categorized at baseline as having no DR (NDR), simple DR (SDR). The primary endpoint was the onset of DR from NDR, and the secondary endpoint was the progression of DR from SDR. Kaplan–Meier and Cox proportional hazards analyses were employed for statistical evaluation. Results: The study included 1972 patients (1702 with NDR and 270 SDR). In the overall NDR cohort, hyperuricemia was not significantly associated with the onset or progression of DR. However, upon stratification by baseline HbA1c, hyperuricemia was significantly associated with a higher incidence of DR within the high-HbA1c subgroup (≥9%) of the NDR cohort (HR 2.40, 95% CI [1.27–4.55]). Similarly, within the SDR cohort, a Kaplan–Meier analysis demonstrated a significantly higher rate of DR progression in the hyperuricemia group, exclusively among patients with HbA1c ≥ 9% (p = 0.01). Conclusions: Hyperuricemia is independently associated with the onset and progression of DR in T2D patients with poor glycemic control While often co-occurring with other DR risk factors, hyperuricemia may serve as a potential marker for the development of retinopathy in this high-risk population.