Front Endocrinol (Lausanne). 2026 Jul 15;17:1866206. doi: 10.3389/fendo.2026.1866206. eCollection 2026.
ABSTRACT
BACKGROUND AND AIM: Diabetic retinopathy (DR) and diabetic kidney disease share common microvascular mechanisms, whereas carotid plaque reflects systemic atherosclerotic burden in type 2 diabetes (T2D). We examined the association between urinary albumin-to-creatinine ratio (ACR) and prevalent diabetic retinopathy (DR) in patients with type 2 diabetes and conducted exploratory analyses to assess whether this association differed according to carotid plaque status.
METHODS: This cross-sectional study included 502 patients with T2D. DR was assessed using fundus photography, and carotid plaque was evaluated by ultrasonography. Because of its skewed distribution, ACR was natural log-transformed as lnACR. Multivariable logistic regression was used to examine the association between lnACR and DR. Subgroup and interaction analyses were performed according to carotid plaque status.
RESULTS: Among 502 participants, 95 (18.9%) had DR. In the extended logistic regression model adjusted for selected clinical covariates, lnACR was associated with prevalent DR (adjusted OR = 1.291, 95% CI: 1.045-1.595, P = 0.018). In a modified Poisson sensitivity analysis using the same covariates, the association was directionally similar but attenuated and did not reach statistical significance (adjusted PR = 1.160, 95% CI: 0.975-1.380, P = 0.094). The point estimate for the lnACR-DR association was numerically larger among participants with carotid plaque than among those without plaque, but the multiplicative interaction was not statistically significant (P for interaction = 0.220).
CONCLUSIONS: Higher lnACR was associated with prevalent DR in adjusted logistic regression, whereas the corresponding modified Poisson sensitivity analysis showed an attenuated, non-significant association. Carotid plaque-related findings were exploratory, and no statistically significant interaction was observed. Because of the cross-sectional complete-case design, these findings should not be interpreted as evidence of incident DR risk, prediction, or support for changes in ophthalmic screening practice.
PMID:42528665 | PMC:PMC13414848 | DOI:10.3389/fendo.2026.1866206