VALUE OF URINARY ALBUMIN CREATININE RATIO AS A PREDICTOR OF TYPE 2 DIABETES IN PRE-DIABETIC INDIVIDUALS

Abstract

Objective: The albumin to creatinine ratio (ACR) is a reflection of urinary albumin excretion and increasingly 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 ACR might serve this purpose. We therefore determined whether ACR could predict incident diabetes in a well-characterized cohort of pre-diabetic Americans.

Research Design and Methods: 3188 Diabetes Prevention Program (DPP) participants with mean body mass index of 34 kg/m², elevated fasting glucose, impaired glucose tolerance, and baseline UAE measurements were followed for incident diabetes over a mean of 3.2 years.

Results: 94% of participants manifested ACR levels below the microalbuminuria range and 21% ultimately developed diabetes during follow-up. Quartiles of ACR [median (range) within quartiles, Q1: 3.0 (0.7 to 3.7); Q2: 4.6 (2.7 to 5.5); Q3: 7.1 (5.5 to 9.7); Q4: 16.5 (9.7 to 1598)] were positively associated with age, markers of adiposity and insulin secretion and resistance, blood pressure, and use of anti-hypertensive agents with anti-proteinuric 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, metformin), we found no consistent trend in incident diabetes by quartile or decile of ACR.

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