Objective:

To examine the association between urinary albumin-to-creatinine ratio (ACR) and prevalent diabetic retinopathy (DR) in patients with type 2 diabetes, and to explore whether this association differs according to carotid plaque status.

Approach:

• Study Design: Cross-sectional study including 502 patients with type 2 diabetes, assessing DR via fundus photography and carotid plaque via ultrasonography.
• Data Analysis: Multivariable logistic regression was used to analyze the association between natural log-transformed ACR (lnACR) and DR, with subgroup analyses based on carotid plaque status.

Key Findings:

• 18.9% of participants had diabetic retinopathy (DR).
• Higher 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, the association was attenuated and non-significant (adjusted PR = 1.160, 95% CI: 0.975–1.380, P = 0.094).
• The lnACR–DR association was numerically larger among participants with carotid plaque, but not statistically significant (P for interaction = 0.220).

Interpretation:

The findings indicate an association between higher urinary albumin levels and the presence of diabetic retinopathy, although the relationship varied across different analytical methods.

Limitations:

• Cross-sectional design limits causal inference.
• Findings are based on a specific population (Southern Han Chinese), which may not be generalizable.
• Exploratory nature of carotid plaque-related analyses without definitive conclusions.

Conclusion:

Higher urinary albumin levels are associated with prevalent diabetic retinopathy, but these findings should not be interpreted as evidence of incident DR risk.