title: Value of urinary albumin-to-creatinine ratio as a predictor of type 2 diabetes in pre-diabetic individuals.
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.
  
  
  METHODS
  A total of 3,188 Diabetes Prevention Program (DPP) participants with a mean BMI of 34 kg/m(2) 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.
authors.affiliation: Indiana University, Indianapolis, Indiana, USA.
authors.forename: Allon N
authors.initials: AN
authors.lastname: Friedman
authors.forename: Allon
authors.initials: A
authors.lastname: Friedman
authors.forename: David
authors.initials: D
authors.lastname: Marrero
authors.forename: Yong
authors.initials: Y
authors.lastname: Ma
authors.forename: Ronald
authors.initials: R
authors.lastname: Ackermann
authors.forename: K M Venkat
authors.initials: KM
authors.lastname: Narayan
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barrett-Connor
authors.forename: Karol
authors.initials: K
authors.lastname: Watson
authors.forename: William C
authors.initials: WC
authors.lastname: Knowler
authors.forename: Edward S
authors.initials: ES
authors.lastname: Horton
mesh_terms: D000328:Adult; D000418:Albumins / Q000378:metabolism; D003404:Creatinine / Q000652:urine*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000652:urine*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000150:complications / Q000652:urine*
chemical_list: D000418:Albumins; D003404:Creatinine
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