Urinary albumin : creatinine ratio predicts prediabetes progression to diabetes and reversal to normoglycemia: role of associated insulin resistance, inflammatory cytokines and low vitamin D

J Diabetes. 2014 Jul;6(4):316-22. doi: 10.1111/1753-0407.12112. Epub 2013 Dec 17.


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).

Conclusion: 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.

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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Albuminuria / diagnosis*
  • Albuminuria / etiology
  • Albuminuria / metabolism
  • Blood Glucose / analysis
  • Cohort Studies
  • Creatinine / urine*
  • Cytokines / blood*
  • Diabetes Mellitus, Type 2 / diagnosis*
  • Diabetes Mellitus, Type 2 / etiology
  • Diabetes Mellitus, Type 2 / metabolism
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Glucose Intolerance
  • Glucose Tolerance Test
  • Humans
  • Inflammation Mediators / blood*
  • Insulin Resistance*
  • Male
  • Middle Aged
  • Prediabetic State / complications
  • Prediabetic State / metabolism*
  • Prognosis
  • Vitamin D / analogs & derivatives*
  • Vitamin D / blood


  • Blood Glucose
  • Cytokines
  • Inflammation Mediators
  • Vitamin D
  • 25-hydroxyvitamin D
  • Creatinine