Association between albuminuria and prevalent diabetic retinopathy in type 2 diabetes: a cross-sectional study with exploratory analysis by carotid plaque status.

Background and aim: Diabetic retinopathy (DR) and diabetic kidney disease share common microvascular mechanisms, whereas carotid plaque reflects systemic atherosclerotic burden in type 2 diabetes (T2D). We examined the association between urinary albumin-to-creatinine ratio (ACR) and prevalent diabetic retinopathy (DR) in patients with type 2 diabetes and conducted exploratory analyses to assess whether this association differed according to carotid plaque status. Methods: This cross-sectional study included 502 patients with T2D. DR was assessed using fundus photography, and carotid plaque was evaluated by ultrasonography. Because of its skewed distribution, ACR was natural log-transformed as lnACR. Multivariable logistic regression was used to examine the association between lnACR and DR. Subgroup and interaction analyses were performed according to carotid plaque status. Results: Among 502 participants, 95 (18.9%) had DR. In the extended logistic regression model adjusted for selected clinical covariates, lnACR was associated with prevalent DR (adjusted OR = 1.291, 95% CI: 1.045-1.595, Conclusions: Higher lnACR was associated with prevalent DR in adjusted logistic regression, whereas the corresponding modified Poisson sensitivity analysis showed an attenuated, non-significant association. Carotid plaque-related findings were exploratory, and no statistically significant interaction was observed. Because of the cross-sectional complete-case design, these findings should not be interpreted as evidence of incident DR risk, prediction, or support for changes in ophthalmic screening practice.