Assessment of the Fibrinogen-to-Albumin Ratio in Patients with Type 2 Diabetes Mellitus: A Comparative Analysis with a Control Group

Abstract

Objective: Previous studies have reported an association between the fibrinogen-to-albumin ratio and diabetic complications; however, its role prior to the development of overt complications remains unclear. This study aimed to evaluate fibrinogen-toalbumin ratio levels in patients with type 2 diabetes mellitus without complications and to compare them with those in patients with established microvascular complications and healthy controls. In addition, the association between the fibrinogen-toalbumin ratio and glycemic parameters was examined. Methods: This retrospective study consisted of 305 patients (244 with type 2 diabetes mellitus and 61 controls), aged 27–77 years, followed at the Internal Medicine Outpatient Clinic of a tertiary hospital between October 1, 2023, and March 31, 2024. Patients with diabetes were categorized into four subgroups with equal sample sizes: those without diabetic complications, those with isolated diabetic neuropathy, those with isolated microalbuminuria, and those with at least two diabetic complications. Fasting blood glucose, HbA1c, fibrinogen, fibrinogen-to-albumin ratio, albumin, and microalbumin levels were compared between the groups. To identify the independent predictors of the burden of complications, a multinomial logistic regression analysis was applied. Results: The fibrinogen-to-albumin ratio did not differ significantly between the controls and patients without complications (p>0.05); however, it was significantly elevated in patients with complications (p<0.001). The ratio increased progressively across complication groups and exhibited a moderate positive correlation with fasting blood glucose and glycated hemoglobin levels (p<0.001). In multivariable analysis, the fibrinogen-to-albumin ratio was independently associated with increasing complication burden, while age, sex, and glycated hemoglobin were not. Conclusion: In patients with type 2 diabetes mellitus, a higher Fibrinogen-to-albumin ratio is associated with an increased risk of diabetic microvascular complications. This association is independent and progressive. Higher levels are linked to both isolated and multiple complications, suggesting its potential role as a simple marker for identifying patients at increased risk of complication development.

Keywords

• type 2 diabetes mellitus
• fibrinogen
• diabetic neuropathy
• diabetic microalbuminuria

Tip 2 Diyabetes Mellituslu Hastalarda Fibrinojen-Albümin Oranının Değerlendirilmesi: Kontrol Grubu ile Karşılaştırmalı Bir Analiz

Abstract

Amaç: Daha önceki çalışmalar fibrinojen-albümin oranı ile diyabetik komplikasyonlar arasında bir ilişki olduğunu bildirmiş olsa da, belirgin komplikasyonlar gelişmeden önceki rolü henüz net değildir. Bu çalışma, komplikasyonu olmayan tip 2 diyabetes mellitus hastalarında fibrinojen-albümin oranı düzeylerini değerlendirmeyi ve bu düzeyleri yerleşmiş mikrovasküler komplikasyonları olan hastalar ile sağlıklı kontrollerle karşılaştırmayı amaçlamıştır. Ayrıca, fibrinojen-albümin oranı ile glisemik parametreler arasındaki ilişki de araştırılmıştır. Yöntemler: Bu retrospektif çalışmada, 1 Ekim 2023 ile 31 Mart 2024 tarihleri arasında bir üçüncü basamak hastanenin Dahiliye Polikliniği'nde izlenen, yaşları 27 ile 77 arasında değişen 305 hasta (244 tip 2 diyabet mellitusu olan ve 61 kontrol) yer aldı. Diyabetik hastalar, eşit örneklem büyüklüğüne sahip dört alt grupta sınıflandırıldı: diyabetik komplikasyonu olmayan hastalar, izole diyabetik nöropatisi olan hastalar, izole mikroalbüminürisi olan hastalar ve en az iki diyabetik komplikasyona sahip olan hastalar. Tüm gruplar açlık kan şekeri, HbA1c, fibrinojen, fibrinojen/albumin oranı, albümin ve mikroalbümin düzeyleri açısından karşılaştırıldı. Komplikasyon yükünün bağımsız belirleyicilerini saptamak amacıyla multinomiyal lojistik regresyon analizi yapıldı. Bulgular: Kontrol grubu ile Grup 1 arasında fibrinojen/albumin oranı açısından istatistiksel olarak anlamlı bir fark gözlenmedi (p>0,05). Ancak, kontrol grubu ile diğer gruplar arasında anlamlı bir fark bulundu (p<0,001). Korelasyon analizinde, fibrinojen/albumin oranı ile hem açlık kan şekeri hem de HbA1c düzeyleri arasında orta düzeyde pozitif bir korelasyon saptandı (p<0,001). Çok değişkenli analizde, fibrinojen-albümin oranının artan komplikasyon yükü ile bağımsız olarak ilişkili olduğu, buna karşın yaş, cinsiyet ve glikozile hemoglobin düzeylerinin anlamlı bulunmadığı saptandı. Sonuç: Tip 2 diyabetes mellitus hastalarında, fibrinojen-albümin oranı diyabetik mikrovasküler komplikasyon yükü ile bağımsız ve kademeli olarak ilişkilidir. Daha yüksek düzeyler hem izole hem de çoklu komplikasyonlarla bağlantılı olup, bu durum fibrinojen-albümin oranının komplikasyon gelişimi açısından artmış risk taşıyan hastaları belirlemede basit bir belirteç olarak potansiyel rolünü düşündürmektedir.

Keywords

• tip 2 diyabetes mellitus
• fibrinojen-albümin oranı
• diyabetik nöropati
• diyabetik mikroalbüminüri

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