Association of urinary albumin-to-creatinine ratio with cardiometabolic risk markers and pre-diabetes in adults with normoglycemia, normoalbuminuria, and normotension with parental type 2 diabetes

Abstract

Introduction: This is a post hoc analysis of urinary albumin-to-creatinine ratio (uACR) within the normoalbuminuric range in relation to cardiometabolic risk factors among initially normoglycemic, normotensive participants in the Pathobiology of Prediabetes in a Biracial Cohort (POP-ABC) Study.

Research design and methods: 308 healthy African American (AA) and European American (EA) participants in the POP-ABC Study underwent baseline assessments, including oral glucose tolerance test, anthropometry, urinary albumin-to-creatinine ratio (uACR), lipids, adipocytokines, insulin sensitivity and secretion. Participants were followed quarterly for 5.5 years (mean 2.62 years) for the primary outcome of incident pre-diabetes.

Results: The cohort's mean fasting glucose was 92.1±6.90 mg/dL, 2-hour plasma glucose was 123±25.0 mg/dL, systolic blood pressure was 123±15.9 mm Hg, and diastolic blood pressure was 74±8.80 mm Hg. Baseline uACR levels (range 1-29 mg/g) were similar in AA versus EA participants (6.40 mg/g±4.80 vs 6.80±5.40 mg/g, p=0.52), higher in women than men (7.30 mg/g±5.30 vs 4.60±3.90 mg/g, p<0.0001), and showed significant associations with cardiometabolic risk factors, including age, insulin sensitivity, high-density lipoprotein cholesterol, and adiponectin levels (p=0.03-0.004). During 5.5 years of follow-up, 104 participants developed pre-diabetes and 204 maintained normoglycemia. Baseline uACR quartiles were associated with incident pre-diabetes (r=0.19, p=0.0011).

Conclusions: Baseline uACR levels were associated with cardiometabolic risk markers and incident pre-diabetes risk among adults with normoglycemia, normoalbuminuria and normotension with parental diabetes.

Keywords: Albuminuria; Ethnic Groups; Impaired Fasting Glucose; Impaired Glucose Tolerance.

Figure 1

Percentile distribution of urinary albumin-to-creatinine ratio (uACR) in (A) black (purple symbol) and white (green symbol) participants and (B) female (blue symbol) and male (red symbol) participants in the POP-ABC Study. uACR distribution was similar in black versus white participants but significantly higher in women than men (p<0.0001). POP-ABC, Pathobiology of Prediabetes in a Biracial Cohort.

Figure 2

Association of urinary albumin-to-creatinine ratio (uACR) with (A) serum high-density lipoprotein (HDL) cholesterol levels, (B) serum adiponectin levels and (C) insulin sensitivity in African American (red symbols) and European American (blue symbols) study participants; (D) pre-diabetes incidence across quartiles of baseline uACR among female study participants (uACR quartiles (mg/g): Q1: 0–<4; Q2: 4–<6; Q3: 6–<9; Q4: 9–<30).