Study of "Fibrinogen-Albumin Ratio" and Urinary Sediments as Biomarkers of Diabetic Microvascular Complications

Global incidence of diabetes, and in India, the incidence of type 2 diabetes is on the rise. Diabetic microvascular complications if detected early can be treated to decrease the mortality and morbidity of diabetes. Hence, this study of the fibrinogen-albumin ratio (FAR) ratio and urinary sediments as the possible markers of early diabetic microvascular complications.

This study aimed to study the FAR ratio and urinary sediments in type 2 diabetic patients and correlate with microvascular complications, namely nephropathy, retinopathy, and neuropathy.

This was a cross-sectional, observational study conducted on 120 type 2 diabetic patients. Fasting and postprandial blood sugar, hemoglobin A1C (HbA1c), renal function tests, liver function tests, including serum albumin and plasma fibrinogen, were measured. FAR was calculated as fibrinogen (mg/dL)/albumin (g/dL). Both urine microscopy and an automated urinary sediment analyzer performed urinary sediment analysis. Fundoscopy was performed for retinopathy assessment, urinary albumin-creatinine ratio, estimated glomerular filtration rate for nephropathy, and nerve conduction velocity for neuropathy. Data were analyzed using the appropriate statistical tests, with P < 0.05 considered statistically significant.

Mean HbA1c was 8.38% ±2.47%, reflecting poor glycemic control. Mean serum albumin was 3.60 ± 0.75 g/dL and mean FAR was 100.15% ±32.88. 75% of patients had FAR >75.4. Diabetic retinopathy was present in 27.5% (n = 33), nephropathy in 35.8% (n = 43), and neuropathy in 4.2% (n = 5). FAR was significantly associated with nephropathy (P = 0.031) and showed a directional trend with retinopathy across tertiles (P = 0.104). Of the urinary sediments, squamous epithelial cells were significantly associated with retinopathy (P = 0.016) and nephropathy (P < 0.001). Cast type distribution was significantly associated with nephropathy (P = 0.003) and pathological casts with neuropathy (P = 0.042).