Abstract:Objective To analyze the dose-response relationship between the glycated albumin（GA）/glycated hemoglobin（HbA1c）ratio and renal lesion progression in patients with type 2 diabetes mellitus（T2DM）using a restricted cubicspline（RCS）model，and to provide a reference for predicting renal lesion progression Methods A total of 90 T2DMpatients admitted to Anqing First People’s Hospital Affiliated to Anhui Medical lesion University from August 2021 to May 2024 were enrolled，and followed up until May 2025（the endpoint event was renal lesion progression）. The patients were divided into the progression group（n=19）and non -progression group（n=71）according to whether renal lesion progression occurred. The GA/HbA1c ratio and other clinical data were compared between the two groups.Multivariate logistic regression analysis was used to identify the risk factors for renal lesion progression in T2DMpatients. The RCS model was applied to analyze the dose-response relationship between the GA/HbA1c ratio and renal lesion progression in T2DM patients，and a receiver operating characteristic（ROC）curve was plotted to evaluate the predictive value of the GA/HbA1c ratio for renal lesion progression in T2DM patients. Results The proportion of hypertension，as well as the levels of serum creatinine，blood urea nitrogen，serum uric acid，cystatin C，and GA/HbA1c ratio in the progression group were higher than those in the non-progression group（P<0.05）. Logistic regression analysis showed that hypertension，elevated blood urea nitrogen，cystatin C，and GA/HbA1c ratio were risk factors for renal lesion progression in T2DM patients（P<0.05）. The RCS model revealed a non -linear dose-response relationship between the GA/HbA1c ratio and renal lesion progression in T2DM patients（P=0.034，P for nonlinear=0.040），and therisk of renal lesion progression events in T2DM patients gradually increased with the increase of the GA/HbA1c ratio. The ROC curve showed that the area under the curve of the GA/HbA1c ratio for predicting renal lesion progression in T2DMpatients was 0.869（95%CI：0.820-0.912），with an optimal cut-off value of 2.025，a sensitivity of 85.00%，and a specificity of 75.00%. Conclusion There is a nonlinear dose-response relationship between the GA/HbA1c ratio and renal lesion progression in T2DM patients. An elevated GA/HbA1c ratio is associated with an increased risk of renal lession progression eventsin T2DM patients，and has good predictive value for the occurrence of renal lesion progression events in T2DM patients.