Early kidney involvement in T2DM may be detectable through routine urine sediment testing. A study in Diabetes, Metabolism, Research and Reviews evaluated whether urine cast characteristics help identify or predict DKD.

A total of 600 hospitalized adults were evaluated, including 299 with DKD and 301 without DKD. Urinalysis findings, including GC, were analyzed along with clinical and biochemical data. Logistic regression assessed the independent relationship between GC and DKD. Diagnostic performance was examined using receiver operating characteristic (ROC) analysis.

GC detection was significantly higher in the DKD group (19.7% vs 1.0%) with greater average counts (0.55 ± 1.68 vs 0.01 ± 0.10). GC remained an independent risk factor for DKD (odds ratio 4.696; 95% CI 1.094–20.168) after multivariable adjustment. ROC analysis demonstrated 19.7% sensitivity and 99.0% specificity for DKD identification at a GC cutoff of 0.5.

Among non-DKD patients, those with GC had a higher incidence of new-onset DKD at one year (66.7% vs 12.05%).

These findings indicate that GC presence may reflect both current kidney involvement and future progression risk in T2DM. Broader validation in outpatient settings is needed due to limited sensitivity and study population characteristics.