BACKGROUND: The impact of serum uric acid (SUA) levels on metabolic disorders, particularly concerning the development or reversal of prediabetes, is not well understood. While high uric acid is recognized for its association with metabolic disturbances, its specific influence on prediabetes progression and regression has been insufficiently explored. This study investigates how SUA levels correlate with the natural course of prediabetes, shedding light on its management. METHODS: A cohort of 3659 individuals diagnosed with prediabetes at Nanjing First Hospital was tracked over three years. Follow-up assessments included fasting plasma glucose and hemoglobin A1c (HbA1c) measurements. Serum uric acid was measured initially and categorized into quartiles (Q1 through Q4). To assess the impact of uric acid levels on shifting prediabetes status, methods such as restricted cubic spline, segmented regression, stratified analysis, and receiver operating characteristic curves were utilized in a multinomial logistic regression framework. RESULTS: At baseline, all 3659 participants had prediabetes
by the three-year mark, 2626 remained in this category, 523 reverted to normal fasting glucose (NFG), and 510 advanced to diabetes. After adjustment for potential confounders, a positive correlation was found between higher SUA levels and progression to diabetes (Odds ratio [OR] 1.182, 95% confidence interval [CI]: 1.095-1.276), with no significant link to reversion to NFG (OR: 0.987, 95% CI: 0.909-1.073). CONCLUSION: Elevated SUA levels are linked with a higher likelihood of progressing from prediabetes to diabetes but do not significantly forecast a regression to NFG.