Prevalence and Determinants of Elevated Urinary Albumin-Creatinine Ratio Among Patients With Type 2 Diabetes Mellitus: A Real-World Study From South Punjab, Pakistan.

Objective This study aimed to determine the prevalence and determinants of elevated urinary albumin-creatinine ratio (UACR) among type 2 diabetes mellitus (T2DM) patients. Methodology This analytical cross-sectional study was conducted from January to June 2025 at the Medicine Outpatient Department of Aleena Hospital, Bahawalpur, South Punjab, Pakistan. Adults with T2DM (duration ≥ 6 months) were enrolled, and relevant sociodemographic and clinical data were gathered. Elevated UACR was defined as UACR ≥ 30 mg/g. Data were analyzed using IBM SPSS Statistics, version 26.0 (IBM Corp., Armonk, NY). To determine independent predictors of elevated UACR, multivariate logistic regression analysis was performed, with adjusted odds ratios (aORs) and 95% confidence intervals (CIs) reported. A p-value < 0.05 was considered statistically significant. Results Of 495 T2DM patients, 260 (52.5%) were male, and the median age was 50.0 (42.0-56.0) years. The median BMI was 28.7 (25.4-32.0) kg/m², with 393 (79.4%) having a BMI ≥ 25 kg/m². Hypertension was present in 229 (46.3%) patients, and a family history of diabetes was present in 308 (62.2%) patients, whereas the median diabetes duration was 5.0 (3.0-10.0) years. Microalbuminuria (UACR between 30.0-299.0 mg/g) was found in 167 (33.7%) patients, and macroalbuminuria (UACR ≥ 300 mg/g) was found in 29 (5.9%) patients, giving an elevated UACR level in 196 (39.6%) patients. In the multivariable model, diabetes duration (aOR: 1.1 per year, 95% CI: 1.0-1.1, p = 0.010) and ankle-brachial index (ABI) values of 0.9-1.3 (aOR: 3.2, 95% CI: 1.5-6.9, p = 0.002) and > 1.3 (aOR: 3.6, 95% CI: 1.4-9.1, p = 0.007) remained significant predictors of elevated UACR. Conclusions Elevated UACR is very common among patients with T2DM in South Punjab. The critical independent factors include longer diabetes duration and abnormal ABI, which support the importance of regular screening for cardiovascular disease and peripheral vascular disease, as well as prompt screening for diabetic kidney disease in outpatient care, especially in resource-limited settings.