Urinary albumin : creatinine ratio predicts prediabetes progression to diabetes and reversal to normoglycemia: Role of associated insulin resistance, inflammatory cytokines and low vitamin D

作者：Dutta Deep^*; Choudhuri Subhadip; Mondal Samim Ali; Mukherjee Satinath; Chowdhury Subhankar

来源：Journal of Diabetes, 2014, 6(4): 316-322.

DOI：10.1111/1753-0407.12112

• albumin : creatinine ratio
• diabetes
• prediabetes
• systemic inflammation
• vitamin D

Background: The relationship between albumin : creatinine ratio (ACR), insulin resistance (IR), cytokines, dyslipidemia, and 25-hydroxy vitamin D (25-OHD) in individuals with prediabetes (IPD) was investigated to evaluate their role in predicting future risk of progression to diabetes.
Methods: The aforementioned parameters were evaluated in 147 IPD with persistent impaired fasting glucose and/or impaired glucose tolerance over two oral glucose tolerance tests, who were then followed up at 3-monthly intervals for progression to diabetes or reversal to normoglycemia.
Results: Data were analyzed for 137 IPD with at least 1-year follow-up. Forty-three IPD reversed to normoglycemia (Group I), 69 continued with prediabetes (Group II), and 25 progressed to diabetes (Group III) over a mean follow-up period of 28.36 +/- 8.19 months. Baseline fasting blood glucose levels (BGLs), 2-h post-glucose BGLs, and ACR were lowest in Group I and highest in Group III. Of the 137 IPD, 54.75% (n = 75) had microalbuminuria. The IPD in the lowest ACR quartile had the highest reversal to normoglycemia. Cox regression revealed that baseline IL-6 was predictive of progression to diabetes (P = 0.03) and ACR was an independent predictor of reversal to normoglycemia (P = 0.007). Kaplan-Meier analysis showed higher reversal to normoglycemia in IPD without microalbuminuria (P < 0.001).
Conclusion: An increased ACR is associated with higher creatinine, IR, and cytokine levels and lower 25-OHD levels in IPD. Microalbuminuria is associated with decreased reversal to normoglycemia and increased progression to diabetes. Low 25-OHD may be associated with increased progression to diabetes, perhaps via modulation of the ACR.

• 出版日期2014-7