Sex-specific threshold effect of albumin-corrected fructosamine on diabetic retinopathy: a nonlinear relationship in women but linear in men - a cross-sectional study.
Albumin-corrected fructosamine (AlbF) is a short-term glycemic marker that can substitute for HbA1c when HbA1c is unreliable. Studies have linked AlbF to diabetic retinopathy (DR), but it is not known whether the dose-response curve differs between men and women. We investigated this in 1,090 type 2 diabetes patients (433 men, 657 women) from a single Chinese center.
Restricted cubic splines were used to model the AlbF-DR relationship separately by sex, with threshold identification via segmented logistic regression. Models included age, BMI, diabetes duration, systolic blood pressure, HbA1c, HDL-C, and medications as covariates.
Each 10 μmol/g increase in AlbF raised DR risk in both sexes: men OR 1.83 (95% CI 1.39-2.41), women OR 1.58 (95% CI 1.26-1.99). The RCS curves told a different story. Men followed a linear pattern (P for nonlinearity = 0.751). Women showed a threshold near 62.0 μmol/g (P for nonlinearity < 0.001). Below that value, the OR was 2.57 (95% CI 1.74-3.81); above it, the association was no longer significant (OR 1.29, 95% CI 0.69-2.42; P for interaction < 0.001). Sensitivity analyses consistently reproduced this nonlinear pattern.
The AlbF-DR relationship is linear in men but follows a threshold model in women, with a change point near 62.0 μmol/g. Sex-specific risk modeling may improve DR stratification. Whether the threshold holds in practice will require prospective studies.
Restricted cubic splines were used to model the AlbF-DR relationship separately by sex, with threshold identification via segmented logistic regression. Models included age, BMI, diabetes duration, systolic blood pressure, HbA1c, HDL-C, and medications as covariates.
Each 10 μmol/g increase in AlbF raised DR risk in both sexes: men OR 1.83 (95% CI 1.39-2.41), women OR 1.58 (95% CI 1.26-1.99). The RCS curves told a different story. Men followed a linear pattern (P for nonlinearity = 0.751). Women showed a threshold near 62.0 μmol/g (P for nonlinearity < 0.001). Below that value, the OR was 2.57 (95% CI 1.74-3.81); above it, the association was no longer significant (OR 1.29, 95% CI 0.69-2.42; P for interaction < 0.001). Sensitivity analyses consistently reproduced this nonlinear pattern.
The AlbF-DR relationship is linear in men but follows a threshold model in women, with a change point near 62.0 μmol/g. Sex-specific risk modeling may improve DR stratification. Whether the threshold holds in practice will require prospective studies.
Authors
Long Long, Kang Kang, He He, Wang Wang, Qi Qi, Lin Lin, Song Song, Guo Guo, Liu Liu
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