Liang Yongqi, Zhou Rui, Jin Chenxi, Liang Jingjing, Wang Xiaoyan, Fan Weidong, Wu Xianbo, Zou Mengchen
Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China.
Department of Epidemiology, School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China.
Nutrients. 2024 Dec 30;17(1):113. doi: 10.3390/nu17010113.
An increased risk of multiple secondary diseases has been observed in individuals with diabetes, which contributes to the growing economic burden. Few studies have established the connection of blood urea nitrogen/albumin (BAR) with diabetes, and its link to subsequent diabetic complications and mortality remains unclear. We aimed to explore the association of BAR with the onset of type 2 diabetes mellitus (T2DM) and its dynamic progression.
A total of 20,039 prediabetic participants aged 40-70, without diabetes or related events at baseline, were selected from the UK Biobank. We used a multistate regression model to assess the relationships between BAR and the trajectories of T2DM progression-from pre-T2DM to T2DM, complications, and ultimately mortality. Akaike information criterion (AIC), area under the curve (AUC), and statistic analyses were performed to compare the diagnostic performance of BAR with that of HbA1c for assessing T2DM progressions risk.
Over a mean 13-year follow-up, 5621 incident T2DM cases were identified, and among them, 1295 developed diabetes macrovascular complications, 574 developed diabetes microvascular complications, and 1264 died. BAR was significantly associated with the increased risk of T2DM (HR: 1.05, 95% CI: 1.02, 1.09), subsequent macrovascular complications (HR: 1.18, 95% CI: 1.12, 1.25), microvascular complications (HR 1.18, 95% CI: 1.08, 1.28), and further death (HR 1.18, 95% CI: 1.00, 1.39). The ability of BAR (AUC: 0.938, statistic: 0.739, < 0.001) to predict diabetes progression was inferior to that of hemoglobin A1c (HbA1c) (AUC: 0.949, statistic: 0.809, < 0.001).
Although BAR is significantly positively correlated with the risk of progression at different stages of diabetes, its predictive performance is inferior to that of HbA1c and comparable to that of BUN and albumin. BAR does not demonstrate sufficient clinical significance in predicting diabetes progression, highlighting the need for further investigation.
糖尿病患者发生多种继发性疾病的风险增加，这导致经济负担不断加重。很少有研究证实血尿素氮/白蛋白（BAR）与糖尿病之间的联系，其与随后的糖尿病并发症及死亡率之间的关联仍不明确。我们旨在探讨BAR与2型糖尿病（T2DM）发病及其动态进展之间的关联。
从英国生物银行中选取了20039名年龄在40至70岁之间的糖尿病前期参与者，他们在基线时无糖尿病或相关事件。我们使用多状态回归模型来评估BAR与T2DM进展轨迹（从糖尿病前期到T2DM、并发症以及最终死亡）之间的关系。进行赤池信息准则（AIC）、曲线下面积（AUC）和统计分析，以比较BAR与糖化血红蛋白（HbA1c）在评估T2DM进展风险方面的诊断性能。
在平均13年的随访期间，共识别出5621例新发T2DM病例，其中1295例发生糖尿病大血管并发症，574例发生糖尿病微血管并发症，1264例死亡。BAR与T2DM风险增加（HR：1.05，95%CI：1.02，1.09）、随后的大血管并发症（HR：1.18，95%CI：1.12，1.25）、微血管并发症（HR 1.18，95%CI：1.08，1.28）以及进一步死亡（HR 1.18，95%CI：1.00，1.39）显著相关。BAR预测糖尿病进展的能力（AUC：0.938，统计量：0.739，<0.001）低于糖化血红蛋白（HbA1c）（AUC：0.949，统计量：0.809，<0.001）。
尽管BAR与糖尿病不同阶段的进展风险显著正相关，但其预测性能低于HbA1c，与血尿素氮（BUN）和白蛋白相当。BAR在预测糖尿病进展方面未显示出足够的临床意义，这突出了进一步研究的必要性。
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