Weight cycling may worsen kidney function for adults with type 1 diabetes
Key takeaways:
- Weight cycling is a pattern in which people repeatedly lose and regain body weight.
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Multiple body-weight variability measures were tied to higher risks for adverse renal outcomes in adults with type 1 diabetes.
Adults with type 1 diabetes who partake in weight cycling and repeatedly lose and regain body weight are more likely to develop diabetic kidney disease, researchers reported in The Journal of Clinical Endocrinology & Metabolism.
Marion Camoin, MD, a specialist at the Centre Hospitalier Universitaire de Bordeaux in France, and colleagues wrote about how body weight cycling, also described as “yo-yo dieting,” is prevalent in as many as 35% of men and 55% of women. In a retrospective analysis of the Diabetes Control and Complications Trial (DCCT) and the Epidemiology of Diabetes Interventions and Complications (EDIC) study, adults with greater body weight cycling according to multiple body-weight variability measures were more likely to have a 40% decline in estimated glomerular filtration rate, rapid eGFR decline, stage 3 chronic kidney disease and doubling of serum creatinine level from baseline.
“We showed that high body-weight variability is associated with increased risk of different outcomes of diabetic kidney disease progressions in people with type 1 diabetes, independently of traditional diabetic kidney disease risk factors,” Camoin said in a press release. “To our knowledge, this is the first study showing this association.”
Researchers obtained data from 1,432 participants in the DCCT or EDIC study. Researchers assessed renal outcomes based on four body-weight variability measures. Variability independent of the mean (VIM) was the primary body-weight variability index used in the study. Renal measures were assessed from DCCT baseline visit until 18 years of the EDIC study or the end of the study for each participant.
An eGFR decline of 40% or more was observed for 18.8% of the study population. Each 1 standard deviation (SD) increase in VIM increased the risk for a 40% or greater decline in eGFR (HR = 1.25; 95% CI, 1.09-1.41; P = .001).
Serum creatinine levels doubled from baseline for 8.6% of participants. Each 1 SD increase in VIM raised the risk for doubling of serum creatinine levels (HR = 1.34; 95% CI, 1.13-1.57; P = .001).
Of the study group, 8.9% developed stage 3 CKD during follow-up. Each 1 SD increase in VIM raised the risk for stage 3 CKD by 36% (HR = 1.36; 95% CI, 1.12-1.63; P = .002).
A rapid decline in kidney function with an eGFR decrease of more than 3 mL/min/1.73 m2 per year was observed for 7.1% of the study group. Participants were more likely to have a rapid eGFR decline with each 1 SD increase in VIM (OR = 1.49; 95% CI, 1.15-1.93; P = .003).
Modestly increased albuminuria from baseline was observed in 26% of adults, and severely increased albuminuria occurred in 11.7% of participants.
“Interestingly, associations with the incidence of moderately increased albuminuria or severely increased albuminuria did not remain significant when adjusted for follow-up covariates,” the researchers wrote. “The reasons for these contrasting results are unclear, but it is possible to speculate that the conditions or mechanisms associated with or leading to body-weight variability affect differently the pathophysiological mechanisms of nephron function decline and albuminuria.”
The associations observed between VIM and markers of kidney function were similar with all other body-weight variability measures.
The researchers wrote that people with type 1 diabetes who lose weight should engage in strategies aimed at maintaining their weight loss long term for better health outcomes.
Reference:
- Yo-yo dieting may significantly increase kidney disease risk in people with type 1 diabetes. https://www.endocrine.org/news-and-advocacy/news-room/2025/yo-yo-dieting-may-significantly-increase-kidney-disease-risk-in-people-with-type-1-diabetes. Published Feb. 4, 2025. Accessed Feb. 4, 2025.
Perspective
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Individuals with type 1 and type 2 diabetes are at increased risk for death, but most of this occurs when individuals with diabetes develop chronic kidney disease. This is because the kidney’s role is to maintain the extracellular environment that our cells live in, and in order to do this, it controls the hemodynamic system. Consequently, the most common cause of death in CKD is cardiovascular, and the most common cause of CKD in diabetes is diabetic kidney disease (DKD). Thus, it is important to make the diagnosis of CKD as early as possible to intensify treatment with lifestyle and medications to reduce the risk for progression of CKD and morbidity and mortality related to CKD.
The best treatment for CKD and DKD is prevention. In individuals with type 1 diabetes, prevention has usually meant tight blood sugar control (HbA1c less than 7%) based on the DCCT study, which showed a 54% reduction in the development of DKD for patients assigned tight blood sugar control compared with those assigned to then-standard treatment. Tight blood sugar control with insulin therapy, however, has been associated with weight gain due to the anabolic effect of the hormone. ACE inhibitors have also been effective; although, mostly used when individuals develop albuminuria or have coexisting hypertension. Other drugs like SGLT2 inhibitors have been limited in use due to concerns for diabetic ketoacidosis or have not been tested for CKD prevention in this population. Historically, tight blood sugar has been difficult to achieve until recently with automated insulin delivery systems. These systems reduce hypoglycemia and weight gain.
The study by Camoin and colleagues showed that there was an association between weight cycling and the development of DKD based on a retrospective statistical review of the DCCT/EDIC data. Decreased weight cycling seemed to have a greater effect on tubular function than glomerular since there was no effect on albuminuria. The mechanism for this is not clear, but may be due to changes in SGLT2 activity.
What this means clinically is that automated insulin delivery systems should continue to be considered as a first-line treatment for people with type 1 diabetes to potentially reduce weight cycling and gain. If incretin mimetic drugs or other weight-lowering medications are used for weight loss, they should probably be continued to prevent weight cycling. The FLOW trial with semaglutide (Ozempic, Novo Nordisk) showed improvements in cardiorenal outcomes in a type 2 diabetes population, but one would expect this treatment would have similar results in a type 1 diabetes population. Let’s hope that such a trial will take place.
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