Urinary Albumin/creatinine Ratio Tertiles Predict Risk of Diabetic Retinopathy Progression: a Natural History Study from the Adolescent Cardio-Renal Intervention Trial (AdDIT) Observational Cohort

Overview

Journal Diabetologia

Specialty Endocrinology

Date 2022 Feb 19

PMID 35182158

Authors

Paul Z Benitez-Aguirre

M Loredana Marcovecchio

Scott T Chiesa

Maria E Craig

Tien Y Wong

Elizabeth A Davis

Andrew Cotterill

Jenny J Couper

Fergus J Cameron

Farid H Mahmud

H Andrew W Neil

Timothy W Jones

Lauren A B Hodgson

R Neil Dalton

Sally M Marshall

John Deanfield

David B Dunger

Kim C Donaghue

Affiliations

Soon will be listed here.

Abstract

Aims/hypothesis: We hypothesised that adolescents with type 1 diabetes with a urinary albumin/creatinine ratio (ACR) in the upper tertile of the normal range (high ACR) are at greater risk of three-step diabetic retinopathy progression (3DR) independent of glycaemic control.

Methods: This was a prospective observational study in 710 normoalbuminuric adolescents with type 1 diabetes from the non-intervention cohorts of the Adolescent Cardio-Renal Intervention Trial (AdDIT). Participants were classified as 'high ACR' or 'low ACR' (lowest and middle ACR tertiles) using baseline standardised log ACR. The primary outcome, 3DR, was determined from centrally graded, standardised two-field retinal photographs. 3DR risk was determined using multivariable Cox regression for the effect of high ACR, with HbA, BP, LDL-cholesterol and BMI as covariates; diabetes duration was the time-dependent variable.

Results: At baseline mean ± SD age was 14.3 ± 1.6 years and mean ± SD diabetes duration was 7.2 ± 3.3 years. After a median of 3.2 years, 83/710 (12%) had developed 3DR. In multivariable analysis, high ACR (HR 2.1 [1.3, 3.3], p=0.001), higher mean IFCC HbA (HR 1.03 [1.01, 1.04], p=0.001) and higher baseline diastolic BP SD score (HR 1.43 [1.08, 1.89], p=0.01) were independently associated with 3DR risk.

Conclusions/interpretation: High ACR is associated with greater risk of 3DR in adolescents, providing a target for future intervention studies.

Trial Registration: isrctn.org ISRCTN91419926.

Citing Articles

Association of Albumin-To-Creatinine Ratio With Diabetic Retinopathy Among US Adults (NHANES 2009-2016).

Dai H, Liu L, Xu W Endocrinol Diabetes Metab. 2025; 8(1):e70029.

PMID: 39826101 PMC: 11742259. DOI: 10.1002/edm2.70029.

Development and validation of a diabetic retinopathy risk prediction model for middle-aged patients with type 2 diabetes mellitus.

Wang G, Hu X, Zhao H, Li H, Chu S, Liu D Front Endocrinol (Lausanne). 2023; 14:1132036.

PMID: 37008912 PMC: 10050549. DOI: 10.3389/fendo.2023.1132036.

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