Table 1.

Koch’s postulates adapted to uric acid and diabetes

1. An elevated serum uric acid predicts the development of diabetes (epidemiology) (9,10).

2. Experimentally raising uric acid with fructose causes insulin resistance in rats (11).

3. Lowering serum uric acid improves insulin resistance in fructose-dependent and -independent models of metabolic syndrome (11,12).

4. Cellular mechanisms by which uric acid can induce diabetes have been identified (8).

5. A pilot study reported that lowering serum uric acid improves insulin resistance in subjects with hyperuricemia (13), but this was not shown in subjects administered high doses of fructose (14).