Value of Urinary Albumin-to-Creatinine Ratio as a Predictor of Type 2 Diabetes in Pre-Diabetic Individuals

doi:10.2337/dc08-0148

Value of Urinary Albumin-to-Creatinine Ratio as a Predictor of Type 2 Diabetes in Pre-Diabetic Individuals

Allon Friedman, MD1,
David Marrero, PHD1,
Yong Ma, MS2,
Ronald Ackermann, MD, MPH1,
K.M. Venkat Narayan, MD, MPH, MBA3,
Elizabeth Barrett-Connor, MD4,
Karol Watson, MD5,
William C. Knowler, MD, DRPH6,
Edward S. Horton, MD7 and
for the Diabetes Prevention Program Research Group*

¹Indiana University, Indianapolis, Indiana
²Coordinating Center, George Washington University, Rockville, Maryland
³Emory University, Atlanta, Georgia
⁴University of California, San Diego, La Jolla, California
⁵University of California, Los Angeles–Alhambra, Alhambra, California
⁶National Institutes of Health, Phoenix, Arizona
⁷Joslin Diabetes Center, Boston, Massachusetts

Corresponding author: The Diabetes Prevention Program Coordinating Center, dppmail{at}biostat.bsc.gwu.edu

Abstract

OBJECTIVE—The albumin-to-creatinine ratio (ACR) reflects urinary albumin excretion and is increasingly being accepted as an important clinical outcome predictor. Because of the great public health need for a simple and inexpensive test to identify individuals at high risk for developing type 2 diabetes, it has been suggested that the ACR might serve this purpose. We therefore determined whether the ACR could predict incident diabetes in a well-characterized cohort of pre-diabetic Americans.

RESEARCH DESIGN AND METHODS—A total of 3,188 Diabetes Prevention Program (DPP) participants with a mean BMI of 34 kg/m² and elevated fasting glucose, impaired glucose tolerance, and baseline urinary albumin excretion measurements were followed for incident diabetes over a mean of 3.2 years.

RESULTS—Of the participants, 94% manifested ACR levels below the microalbuminuria range and 21% ultimately developed diabetes during follow-up. Quartiles of ACR (median [range] within quartiles: 1, 3.0 [0.7–3.7]; 2, 4.6 [3.7–5.5]; 3, 7.1 [5.5–9.7]; and 4, 16.5 [9.7–1,578]) were positively associated with age, markers of adiposity and insulin secretion and resistance, blood pressure, and use of antihypertensive agents with antiproteinuric effects and inversely related to male sex and serum creatinine. An elevated hazard rate for developing diabetes with doubling of ACR disappeared after adjustment for covariates. Within the DPP intervention groups (placebo, lifestyle, and metformin), we found no consistent trend in incident diabetes by quartile or decile of ACR.

CONCLUSIONS—An ACR at levels below the microalbuminuria range does not independently predict incident diabetes in adults at high risk of developing type 2 diabetes.

Footnotes

Published ahead of print at http://care.diabetesjournals.org on 16 September 2008.
*
↵* A complete list of the Diabetes Prevention Program Research Group can be found in an online appendix at http://dx.doi.org/10.2337/dc08-0148.
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- Accepted August 19, 2008.
- Received January 25, 2008.
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