Increasing obesity rates in type 1 diabetes associated with chronic kidney disease risk
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Adults with type 1 diabetes are seeing increasing rates of obesity and now have a higher age-adjusted risk for chronic kidney disease than people with type 2 diabetes, according to researchers.
“Our study shows that obesity rates in adults with type 1 diabetes are increasing and mirror the rates in the general adult population,” Elizabeth Selvin, PhD, MPH, professor of epidemiology at Johns Hopkins Bloomberg School of Public Health and John Hopkins University, said in a press release. “Our research also highlights the high risk of kidney disease in people with type 1 diabetes. Kidney disease is often considered more common in people with type 2 diabetes, but our data shows adults with type 1 diabetes actually had a higher risk of kidney disease than those with type 2.”
Selvin and colleagues analyzed data from all patients with type 1 diabetes (n = 4,060; median age, 39 years; 48.5% women) and type 2 diabetes (n = 135,458; median age, 62 years; 50.6% women) from the Geisinger Health System from 2004 to 2018. Trends in obesity (BMI 30 kg/m2), low estimated glomerular filtration rate ( 60 mL/min/1.73 m2) and albuminuria (urine albumin-to-creatinine ratio 30 mg/g) were evaluated along with associations between obesity and CKD.
From 2004 to 2018, there was an increase in obesity rates among patients with type 1 diabetes from 32.6% to 36.8% (P for trend = .0091), whereas obesity rates among patients with type 2 diabetes remained stable at approximately 60%.
Researchers also observed a higher crude prevalence of low eGFR among patients with type 2 diabetes compared with those with type 1 diabetes in 2004 (26.6% vs. 17.5%) and 2018 (30.6% vs. 16.1%). However, after age adjustments, this prevalence was lower among patients with type 2 diabetes compared with those with type 1 diabetes in all years; for example, 9.3% vs. 16.2% in 2018.
Researchers observed obesity increased the likelihood of low eGFR with both type 1 diabetes (adjusted OR = 1.52; 95% CI, 1.12-2.08) and type 2 diabetes (aOR = 1.29; 95% CI, 1.23-1.35).
“Our results highlight the need for interventions to prevent weight gain and end-stage kidney disease in people with type 1 diabetes,” Selvin said.
Reference:
- Obesity is more prevalent in people with type 1 diabetes than previously thought. Available at https://www.endocrine.org/news-and-advocacy/news-room/2022/obesity-is-more-prevalent-in-people-with-type-1-diabetes-than-previously-thought. Published Jan. 26, 2022. Accessed Jan. 26, 2022.
Perspective
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There has been a worldwide epidemic increase in chronic kidney disease due mostly to the epidemic rise in the numbers of people with diabetes. Understanding who is principally at risk in order to mitigate the development and progression of diabetic kidney disease is essential. The study by Wallace and colleagues provides interesting, new information associating obesity and the risk for developing chronic kidney disease in people with type 1 and type 2 diabetes.
In general, there is a perception that people with type 2 diabetes are often obese, whereas people with type 1 diabetes have less of a risk for obesity. In the population evaluated, the finding of increasing obesity in type 1 diabetes over the period evaluated with no change in obesity in people with type 2 diabetes is a very interesting observation. In addition, the analysis showing that obesity and diabetes together increased the odds for lower estimated glomerular filtration rate in both type 1 and type 2 diabetes for chronic kidney disease is of great interest. There has been much debate over a role for obesity per se as a risk factor for kidney disease development and progression.
This retrospective analysis provides a good argument for weight loss as an additional treatment to slow progression of kidney disease. Of note though, the authors appropriately state that the central Pennsylvania population they studied is not very diverse, being mostly non-Hispanic and white, so it is not clear if their findings are generalizable. Lastly, also as discussed in the paper, the importance of raising awareness amongst all health care providers for early screening and early intervention cannot be overstated.
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