Change in Urine Albumin-to-Creatinine Ratio and Risk of Diabetic Peripheral Neuropathy in Type 2 Diabetes: A Retrospective Cohort Study

Figures & data

Table 1 Study Population Characteristics of Non-DPN

	UACR Change Over Two Years
	Decrease Group	Minor Group	Increase Group	P
Age (years)	57.45 ± 10.75	58.29 ± 11.47	62.15 ± 10.53	0.15
Female [n (%)]	18 (54.5%)	17 (41.5%)	24 (61.5%)	0.19
Diabetes duration (years)	7.46 ± 6.29	6.46 ± 5.65	9.52 ± 9.64	0.18
Blood glucose–lowering treatments [n (%)]	30 (91.0%)	37 (90.0%)	35 (90.0%)	0.99
History of hypertension [n (%)]	18 (54.5%)	20 (48.8%)	17 (43.6%)	0.65
SBP (mmHg)	132.58 ± 16.71	130.49 ± 14.10	130.92 ± 14.06	0.82
DBP (mmHg)	80.06 ± 10.23	78.12 ± 9.52	73.21 ± 10.20	0.01*
Heart rate (bpm)	78.33 ± 10.00	76.95 ± 13.37	76.15 ± 11.37	0.73
QT (ms)	0.37 ± 0.03	0.38 ± 0.02	0.38 ± 0.03	0.40
QTC (ms)	0.40 ± 0.03	0.40 ± 0.02	0.40 ± 0.02	0.49
BMI (kg/m2)	25.37 ± 2.33	26.07 ± 3.87	24.87 ± 3.02	0.25
Scr (umol/L)	59.49 ± 15.69	64.52 ± 14.38	61.45 ± 22.07	0.47
BUN (mmol/L)	5.33 ± 1.63	5.29 ± 1.53	5.27 ± 1.50	0.99
TC (mmol/L)	4.76 ± 1.09	4.75 ± 1.28	4.52 ± 0.94	0.58
TG (mmol/L)	1.98 ± 2.23	2.45 ± 2.01	1.36 ± 0.88	0.03*
HDL (mmol/L)	1.18 ± 0.41	1.09 ± 0.39	1.29 ± 0.39	0.10
LDL (mmol/L)	2.92 ± 0.92	2.86 ± 1.14	2.68 ± 0.91	0.54
vLDL (mmol/L)	0.87 ± 1.03	1.07 ± 0.92	0.60 ± 0.41	0.04*
HbA1c (%)	8.34 ± 2.01	8.36 ± 2.35	8.08 ± 2.12	0.82
First UACR(mg/g)	12.95 (8.33,16.95)	6.69 (3.90,11.59)	7.66 (4.15,18.70)	<0.01*
Second UACR (mg/g)	5.21 (4.00,9.19)	5.39 (4.13,10.88)	18.55 (8.04,69.46)	<0.01*
First eGFR (mL/min)	101.27 (95.35,109.89)	101.11 (92.91,108.34)	98.91 (90.72,108.37)	0.30
Second eGFR (mL/min)	101.73 (91.21,108.51)	98.77 (89.25,107.35)	93.55 (86.84,106.15)	0.17
First composite MCV	−3.07 ± 0.79	−3.10 ± 0.79	−3.38 ± 0.80	0.16
Second composite MCV	−3.10 ± 0.86	−2.99 ± 0.82	−3.48 ± 0.81	0.03*
First composite SCV	−0.38 ± 0.69	−0.27 ± 0.78	−1.03 ± 1.78	0.01*
Second composite SCV	−0.34 ± 0.66	−0.26 ± 0.75	−0.68 ± 1.00	0.06
First TCSS	1.31 ± 2.22	1.83 ± 2.66	2.41 ± 2.84	0.22
Second TCSS	2.73 ± 3.17	2.63 ± 3.13	2.71 ± 3.29	0.99

Notes: Decrease group, change rate of UACR ≤ −30%; Minor group, |change rate of UACR| < 30%; Increase group, change rate of UACR ≥ 30%; *was considered statistically significant.

Abbreviations: Composite MCV, composite MCV Z score; composite SCV, composite SCV Z score; DPN, diabetic peripheral neuropathy; GFR, glomerular filtration rate; HbA1c, hemoglobin A1c; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; MCV, motor nerve conduction velocity; NCV, nerve conduction velocity; ROC, receiver operating characteristic curve; Scr, Serum creatinine; SCV, sensory nerve conduction velocity; TCH, total cholesterol; TCSS, Toronto clinical scoring system; TG, triglyceride levels; UACR, urine albumin-to-creatinine ratio.

Table 2 Study Population Characteristics of DPN

	UACR Change Over Two Years
	Decrease Group	Minor Group	Increase Group	P
Age (years)	58.56±8.46	59.87 ± 7.57	61.13 ± 10.63	0.65
Female [n (%)]	9 (0.5)	7 (0.467)	14 (0.452)	0.95
Diabetes duration (years)	8.00 ± 4.99	7.50 ± 4.58	11.94 ± 7.62	0.04*
Blood glucose-lowering treatments [n (%)]	15 (83.3%)	13(86.7%)	31 (100%)	0.07
History of hypertension [n (%)]	5 (27.8%)	8 (53.3%)	19 (61.3%)	0.07
SBP (mmHg)	131.22 ± 11.82	134.27 ± 14.82	135.10 ± 15.83	0.66
DBP (mmHg)	73.56 ± 9.19	72.93 ± 4.79	75.65 ± 8.83	0.50
Heart rate(bpm)	80.83 ± 11.06	77.67 ± 10.04	78.87 ± 9.19	0.65
QT (ms)	0.37 ± 0.03	0.39 ± 0.07	0.37 ± 0.02	0.46
QTC (ms)	0.41 ± 0.02	0.39 ± 0.03	0.41 ± 0.02	0.15
BMI (kg/m^2)	23.40± 2.49	24.05 ± 3.57	25.43 ± 3.79	0.13
Scr (umol/L)	51.06 ± 8.62	58.77 ± 21.38	63.09 ± 17.58	0.04*
BUN (mmol/L)	5.25 ± 1.61	5.18 ± 1.25	5.81 ± 1.98	0.40
TC (mmol/L)	4.66 ± 0.90	4.55 ± 1.01	4.30 ± 1.00	0.43
TG (mmol/L)	1.47 ± 0.57	1.68 ± 0.83	1.50 ± 1.02	0.77
HDL (mmol/L)	1.11 ± 0.32	1.11 ± 0.31	1.16 ± 0.28	0.77
LDL (mmol/L)	2.87 ± 0.87	2.88 ± 0.82	2.57 ± 0.82	0.36
vLDL (mmol/L)	0.60± 0.32	0.67 ± 0.40	0.68 ± 0.47	0.82
HbA1c (%)	9.61 ± 2.08	9.46 ± 2.66	8.65 ± 1.78	0.25
First UACR (mg/g)	9.47 (7.33,16.08)	7.39 (6.13,11.30)	9.83 (4.98,13.23)	0.52
Second UACR (mg/g)	4.89 (3.84,6.68)	7.15 (6.17,11.63)	22.47 (8.29,47.74)	<0.01*
First eGFR (mL/min)	109.69 (101.94,111.13)	104.10 (94.87,109.92)	99.60 (90.92,107.79)	0.14
Second eGFR (mL/min)	100.45 (92.61,111.44)	101.12 (93.69,109.47)	100.35 (88.69,108.31)	0.59
First composite MCV Z score	−3.97 ± 0.83	−3.80 ± 0.70	−3.79 ± 0.75	0.71
Second composite MCV Z score	−3.58 ± 1.01	−3.61 ± 0.87	−3.61 ± 0.92	0.99
First composite SCV Z score	−1.65 ± 0.87	−1.89 ± 1.31	−1.20 ± 0.82	0.12
Second composite SCV Z score	−1.42 ± 1.27	−1.31 ± 1.69	−1.24 ± 1.16	0.90
First TCSS	5.13 ± 3.23	4.73 ± 3.65	3.03 ± 3.62	0.12
Second TCSS	3.06 ± 2.92	4.00± 3.30	3.55 ± 2.54	0.63

Notes: Decrease group, change rate of UACR ≤ −30%; Minor group, |change rate of UACR| < 30%; Increase group, change rate of UACR ≥ 30%; *was considered statistically significant.

Abbreviations: Composite MCV, composite MCV Z score; composite SCV, composite SCV Z score; BMI, body-mass index; DPN, diabetic peripheral neuropathy; GFR, glomerular filtration rate; HbA1c, Hemoglobin A1c; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; MCV, motor nerve conduction velocity; NCV, nerve conduction velocity; ROC, receiver operating characteristic curve; Scr, Serum creatinine; SCV, sensory nerve conduction velocity; TC, total cholesterol; TCSS, Toronto clinical scoring system; TG, triglyceride levels; UACR, urine albumin-to-creatinine ratio.

Figure 1 Changes in NCV and TCSS in non-DPN. (A) Changes of composite SCV in non-DPN; (B) changes of composite MCV in non-DPN; (C) changes of TCSS in non-DPN.

Notes: Decrease group, change rate of UACR ≤ −30%; Minor group, |change rate of UACR| < 30%; Increase group, change rate of UACR ≥ 30%.
Abbreviations: Composite MCV, composite MCV Z score; Composite SCV, composite SCV Z score; NCV, nerve conduction velocity; TCSS, Toronto clinical scoring system; non-DPN, type 2 diabetes patient without diabetic peripheral neuropathy; UACR, urine albumin-to-creatinine ratio.

Figure 2 Changes in NCV and TCSS in DPN. (A) Changes of composite SCV in DPN; (B) changes of composite MCV in DPN; (C) changes of TCSS in DPN.

Notes: Decrease group, change rate of UACR ≤ −30%; Minor group, |change rate of UACR| < 30%; Increase group, change rate of UACR ≥ 30%.
Abbreviations: Composite MCV, composite MCV Z score; Composite SCV, composite SCV Z score; NCV, nerve conduction velocity; TCSS, Toronto clinical scoring system; DPN, type 2 diabetes patient with diabetic peripheral neuropathy; UACR, urine albumin-to-creatinine ratio.

Figure 3 Risk factor for new-onset DPN in non-DPN.

Notes: After adjusting for confounding factors that included the age of the patient, gender, diabetic duration, HbA1C, history of hypertension, use of hypoglycemic drugs, angiotensin converting enzyme inhibitor (ACEI), and statins.
Abbreviations: non-DPN, type 2 diabetes patient without diabetic peripheral neuropathy; UACR, urine albumin-to-creatinine ratio; DPN, type 2 diabetes patient with diabetic peripheral neuropathy; UACR, urine albumin-to-creatinine ratio.

Figure 4 Risk factor for change in NCV in DPN. (A) Risk factor for change in composite SCV in DPN; (B) risk factor for change in composite MCV in non-DPN.

Notes: After adjusting for confounding factors that included the age of the patient, gender, diabetic duration, HbA1C, history of hypertension, use of hypoglycemic drugs, angiotensin converting enzyme inhibitor (ACEI), and statins.
Abbreviations: DPN, type 2 diabetes patient with diabetic peripheral neuropathy; UACR, urine albumin-to-creatinine ratio; Composite MCV, composite MCV Z score; Composite SCV, composite SCV Z score; DPN, type 2 diabetes patient with diabetic peripheral neuropathy; UACR, urine albumin-to-creatinine ratio.

Figure 5 ROC analysis of UACR change in non-DPN patient to indicate DPN.

Abbreviations: non-DPN, type 2 diabetes patient without diabetic peripheral neuropathy; DPN, type 2 diabetes patient with diabetic peripheral neuropathy; ROC, receiver operating characteristic curve.