Sex modifies the association between urinary albumin-to-creatinine ratio and diabetes among adults in the United States (NHANES 2011–2018)

BACKGROUND: Studies on the association between urinary albumin-to-creatinine ratio (uACR) and diabetes are limited. We aimed to examine the association between uACR and diabetes among adults in the United States, with particular interest in sex differences. METHODS: Overall, 5307 participants were included in this study. The exposure variable was uACR, where uACR = urine albumin/urine creatinine. The primary outcome of this study was diabetes, defined as self-reported physician diagnosis of diabetes, fasting plasma glucose concentration ≥ 7.0 mmol/L, or use of glucose-lowering drugs. RESULTS: The average age of the participants in this study was 46.37 ± 17.38 years, 818 (15.41%) had diabetes and the median uACR was 7 mg/g (interquartile range, 4–12 mg/g). There was a significant positive association between uACR and diabetes (per natural log [uACR] increment: OR, 1.81; 95% CI 1.39–2.34). A multivariate logistic regression model demonstrated that per unit increment in LguACR, the diabetes prevalence increased 2.26-fold among male participants (OR 2.26, 95% CI 1.59–3.21). However, in female participants, we observed that uACR was not related to the prevalence of diabetes (odds ratio [OR], 1.28; 95% CI 0.82–2.01). Our findings showed that there was an interaction between sex and uACR (P for interaction = 0.049). CONCLUSIONS: A higher uACR is significantly associated with an increased prevalence of diabetes, and sex can modify the relationship between them.