Sex modifies the association between urinary albumin-to-creatinine ratio and diabetes among adults in the United States (NHANES 2011-2018)

Background Studies on the association between urinary albumin-to-creatinine ratio (uACR) and diabetes are limited. We aimed to examine the association between uACR and diabetes among adults in the United States, with particular interest in sex differences. Methods Overall, 5307 participants were included in this study. The exposure variable was uACR, where uACR = urine albumin/urine creatinine. The primary outcome of this study was diabetes, defined as self-reported physician diagnosis of diabetes, fasting plasma glucose concentration >= 7.0 mmol/L, or use of glucose-lowering drugs. Results The average age of the participants in this study was 46.37 +/- 17.38 years, 818 (15.41%) had diabetes and the median uACR was 7 mg/g (interquartile range, 4-12 mg/g). There was a significant positive association between uACR and diabetes (per natural log [uACR] increment: OR, 1.81; 95% CI 1.39-2.34). A multivariate logistic regression model demonstrated that per unit increment in LguACR, the diabetes prevalence increased 2.26-fold among male participants (OR 2.26, 95% CI 1.59-3.21). However, in female participants, we observed that uACR was not related to the prevalence of diabetes (odds ratio [OR], 1.28; 95% CI 0.82-2.01). Our findings showed that there was an interaction between sex and uACR (P for interaction = 0.049). Conclusions A higher uACR is significantly associated with an increased prevalence of diabetes, and sex can modify the relationship between them.

Automated summary

This study found a significant positive association between urinary albumin-to-creatinine ratio (uACR) and diabetes, and that sex can modify this relationship.