title: Urinary albumin : creatinine ratio predicts prediabetes progression to diabetes and reversal to normoglycemia: role of associated insulin resistance, inflammatory cytokines and low vitamin D.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research (IPGMER) and Seth Sukhlal Karnani Memorial (SSKM) Hospital, Calcutta, India.
authors.forename: Deep
authors.initials: D
authors.lastname: Dutta
authors.forename: Subhadip
authors.initials: S
authors.lastname: Choudhuri
authors.forename: Samim Ali
authors.initials: SA
authors.lastname: Mondal
authors.forename: Satinath
authors.initials: S
authors.lastname: Mukherjee
authors.forename: Subhankar
authors.initials: S
authors.lastname: Chowdhury
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D001786:Blood Glucose / Q000032:analysis; D015331:Cohort Studies; D003404:Creatinine / Q000652:urine*; D016207:Cytokines / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D018149:Glucose Intolerance; D005951:Glucose Tolerance Test; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000150:complications / Q000378:metabolism*; D011379:Prognosis; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood
chemical_list: D001786:Blood Glucose; D016207:Cytokines; D018836:Inflammation Mediators; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D003404:Creatinine
keywords: albumin : creatinine ratio; diabetes; prediabetes; systemic inflammation; vitamin D; 白蛋白:肌酐比值，糖尿病，糖尿病前期，全身性炎症，维生素D