A Retrospective Comparative Study of Urine Albumin Creatinine Ratio over 24 Hour Urine Albumin in Early Detection of complications in Subjects with Type 2 Diabetes Mellitus

Background: Measurement of urinary protein is one of the important markers used for assessing the degree of renal impairment. Early detection of renal impairment is important to give appropriate treatment before it progresses to irreversible stage. Material and Methods: Study design: This was retrospective, comparative study done on 70 patients with type 2 diabetes mellitus in a tertiary care hospital over period of 18 months from October 2019 to March 2021. Enrolled patients underwent fasting blood sugar, postprandial blood sugar, glycosylated HbA1c, Albumin Creatinine ratio in a spot urine sample, 24 hour urinary albumin. Results: The mean age of the subjects was 68.75 ±10.22 years The majority of subjects were males (60%) and females were 40%.The majority of subjects were with Diabetes duration of 6-10 years (44.29%) and the mean duration of diabetes was 8.63 ±3.45 years . The fundoscopy findings of diabetic retinopathy among subjects showed that majority of subjects presented with moderate DR (32.86%) followed by mild DR (28.57%) The proliferative DR was seen in 5 (7.14%) subjects. The mean blood urea of the subjects was 44.43 mg/dl while mean serum creatinine among subjects was 1.44 mg/dl. Mean HbA1c was 7.95% among subjects. The mean 24 hour urine albumin and UACR of the subjects was 252.83mg and 232.71 mg/dl respectively. We observed that majority of subjects presented with value between 30-300 mg (35.71%) with 24 hour urine albumin method. The 24 hour urine albumin value>300 mg was seen in 21 (30%) subjects. Majority of subjects showing Urine albumin to creatinine ratio between 30-300 mg (60%), while value>300 mg was seen in 20 (28.57%) subjects. We observed that 24 hour urine albumin and duration of diabetes mellitus showed statistically significant correlation (p<0.001). With respect to the correlation of Urine albumin to creatinine ratio, various study parameters observed that Urine albumin to creatinine ratio showed significant correlation with HbA1c, FBS, PPBS, diabetes duration and Fundoscopy with statistical significance. (p<0.05).It was observed that 24 Hr Urine Albumin showed significant correlation with HbA1c, FBS, PPBS and diabetes duration with statistical significance (‘p’<0.05). Conclusion: The present study was conducted to find out early diagnosis of renal complications of type 2 diabetes mellitus in the form of diabetic nephropathy. The study was predominated by male gender with a ratio of 3:2 and included 2/3rd subjects in age group 61-80 years. It was found that Urine albumin to creatinine ratio (UACR) was better parameter than 24 hour urine albumin to detect proteinuria in subjects with type 2 diabetes mellitus. There was a positive correlation of Urine albumin to creatinine ratio with duration of diabetes, HbA1c levels, and diabetic retinopathy; indicating the role of early detection of proteinuria and strict glycemic control, to halt the disease progression in subjects with type 2 diabetes mellitus.