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There is a strong independent positive correlation between insulin and insulin resistance with serum urate concentration in a variety of cohorts.29, 30, 31 Insulin resistance reduces renal clearance of urate by increasing its absorption transporter, URAT1 , and decreasing urate excretion through downregulation of the ABCG2 transporter.32, 33, 34, 35, 36 Healthy non–insulin-resistant male individuals given a 2- or 4-hour infusion of insulin develop a temporal and graded reduction of urinary uric acid clearance.37, 38 Insulin resistance treated with diet or medications, without body mass index and/or blood pressure improvement, significantly reduces serum uric acid
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Because PDA is generally described as a formulation of the same peptide sequence, taking both does not automatically create two independent biological mechanisms