Early detection of diabetic nephropathy based on albumin creatinine ratio (acr) in type 2 diabetes mellitus patients in Medan. Indonesia

Introduction
Diabetic nephropathy (DN) is one of the chronic microvascular complications of type 2 diabetes mellitus (T2DM). Microalbuminuria is a marker that can be used in detecting these complications so that preventive measures can be taken. This study aimed to detect DN as T2DM complications by measurement of the urine albumin-to-creatinine ratio (ACR) as a marker and to analyze the factors that may influence the ratio in T2DM patients.

Material and methods
The study design was a correlative study with a cross-sectional approach. The study population was all T2DM patients who regularly visit the diabetic clinic and primary health care in Medan. The sample size consisted of 89 subjects, while the subjects were recruited by consecutive sampling. Data was processed using SPSS and was analyzed using descriptive statistics and one-way ANOVA.

Results
The study results showed that most T2DM patients had normal to mildly increased ACR levels in 49 subjects (55.1%). There was a relationship between increased ACR levels with blood glucose level (BGL) (p = 0.01), HbA1c (p = 0.03), HDL-C (p = 0.01) and triglyceride (p = 0.04). In contrast, increased ACR levels had no relationship with age (p = 0.27), duration of illness (p = 0.13), systolic blood pressure (p = 0.31), total cholesterol (p = 0.90) and LDL-C (p = 0.89), respectively.

Conclusions
The study showed that BGL, HbA1c, HDL-C and triglyceride had a strong relationship with the increased ACR level, which is believed to be a DN marker. ACR can be a screening tool for DN in T2DM patients and other T2DM complications, such as cardiovascular complications and retinopathy.