Evaluating albuminuria as a predictor of subclinical atherosclerosis in type 2 diabetes: a community-based cross-sectional study

Muhammad Rosyid Narendra; Lusiani Lusiani; Dicky Levenus Tahapary; Arif Mansjoer; Pradana Soewondo; Martha Rosana; Ardy Wildan; Ekowati Rahajeng; Woro Riyadina; Dewi Kristanti; Sudikno Sudikno; Felly Philipus Senewe; Em Yunir

Muhammad Rosyid Narendra Department of Internal Medicine, Division of Cardiology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
Lusiani Lusiani Department of Internal Medicine, Division of Cardiology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
Dicky Levenus Tahapary Department of Metabolic Disorder, Cardiovascular and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
Arif Mansjoer Department of Internal Medicine, Division of Cardiology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
Pradana Soewondo Department of Metabolic Disorder, Cardiovascular and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
Martha Rosana Department of Metabolic Disorder, Cardiovascular and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
Ardy Wildan Department of Internal Medicine, Division of Endocrinology, Metabolism, and Diabetes, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
Ekowati Rahajeng Research Center for Biomedical Research, National Research and Innovation Agency, Jakarta, Indonesia
Woro Riyadina Research Center for Biomedical Research, National Research and Innovation Agency, Jakarta, Indonesia
Dewi Kristanti Health Development Policy Agency, Ministry of Health, Jakarta, Indonesia
Sudikno Sudikno Research Center for Biomedical Research, National Research and Innovation Agency, Jakarta, Indonesia
Felly Philipus Senewe Research Center for Biomedical Research, National Research and Innovation Agency, Jakarta, Indonesia
Em Yunir Department of Internal Medicine, Division of Endocrinology, Metabolism, and Diabetes, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

Keywords: albuminuria, carotid intima-media thickness, type 2 diabetes mellitus, atherosclerosis, cardiovascular risk

Abstract

The burden of microvascular and macrovascular complications of type 2 diabetes mellitus (T2DM) in Indonesia is increasing. Albuminuria has been proposed as a marker of atherosclerosis, while carotid intima–media thickness (CIMT) is a validated indicator of subclinical atherosclerosis. Evidence from community-based populations in Indonesia remains limited. To assess the association between albuminuria and CIMT in individuals with T2DM. A cross-sectional study was conducted using secondary data from the PTM Bogor Cohort Follow-Up Study 2019–2020. Participants with available albumin-to-creatinine ratio (ACR) and CIMT measurements were included. Multivariate analyses adjusted for demographic factors, cardiovascular risk factors, and diabetes-related treatments. A total of 195 participants (mean age 56.9±9.0 years; 76.4% women) were analyzed. Normoalbuminuria, microalbuminuria, and macroalbuminuria were observed in 50.3%, 38.5%, and 11.3% of subjects, respectively. The median CIMT was 0.76 mm, with 39.5% exhibiting elevated CIMT. Albuminuria showed a weak correlation with CIMT (r=0.142; p=0.047). After adjustment, albuminuria was not independently associated with CIMT (p=0.878), whereas age (p=0.004) and hypertension (p<0.001) remained significant. ROC analysis demonstrated poor predictive value of ACR for elevated CIMT (AUC 0.489; p=0.795). Albuminuria was not an independent predictor of increased CIMT after adjustment for confounders. ACR has limited utility as a marker of subclinical atherosclerosis in community-based T2DM populations.