The urine stain for albumin: creatinine ratio (UACR) is higher in patients with uncontrolled type 2 diabetes (T2D) and in patients with longer disease duration, according to new research.
The results support the case for annual UACR testing as a routine part of care, the authors concluded, as the tests can detect early signs of diabetic nephropathy.
Diabetic nephropathy is a complication of diabetes associated with chronic kidney disease that leads to end-stage kidney disease. Early detection of Nephropathy can be a key factor in clinical outcomes. The presence of albumin in the urine is linked to diabetic neuropathy. The American Diabetes Association recommends screening for yearly Microalbuminuria. UACR is a more efficient method of testing for albumin and replaces the older standard of 24-hour urine collection.
Corresponding author Ayesha Malik of the Hameed Latif Hospital in Pakistan and colleagues found that strict blood sugar control can prevent microalbuminuria. The researchers wanted to better understand how common microalbuminuria occurs in patients with T2D and how it correlates with control of diabetics.
Malik and colleagues recruited 133 patients for their study and recorded data such as body mass index, duration of diabetes, and hemoglobin A1C levels. Patients were given morning midstream UACR tests which were then checked for albumin.
The study population was predominantly male (60.9%) and had a mean age of 54.5 years. The mean duration of diabetes in the group was 6.29 years and the mean A1C was 8.99%.
In total, 30.1% of the patients had diabetic neuropathy and 25.6% had microalbuminuria. In addition, 4.5% had macroalbuminuria.
The researchers then performed a Pearson Product-Moment Correlation Coefficient, which showed that high UACR correlated with a higher likelihood of uncontrolled diabetes and longer diabetes duration.
“Some of the factors that affect the development of kidney disease are genetics, blood sugar control, and blood pressure,” the authors said. “The influence of strict diabetic control on the prognosis is most pronounced in the patient’s microalbuminuria. We found a significant correlation between higher HbA1c levels and the presence of microalbuminuria. “
The researchers found that T2D is becoming increasingly common around the world, and they said local studies in the South Asian region have shown rates of microalbuminuria in patients with T2D that are consistent with this new study.
“Because of poor health infrastructure and a lack of education, people in developing or underdeveloped countries are not routinely screened and present themselves late in the disease process,” they wrote.
Limitations of the study included the small sample size and the fact that the researchers did not consider the patients’ detailed drug or dietary history of protein intake prior to UACR. These factors can potentially change the UACR values.
Still, the researchers said their data shows that routine UACR testing can be an important part of preventing kidney disease.
“Both early detection and disease progression can be determined by sensitive markers like UACR,” they concluded. “In addition, our study shows that poorly controlled diabetes is associated with higher UACR. The inclusion of UACR in routine practice should be considered for all diabetics. “
The study “Prevalence of Microalbuminuria in Type 2 Diabetes Mellitus” was published online in Cureus.