Obesity and Kidney Disease on the Rise in Patients With Type 1 Diabetes

Obesity and chronic kidney disease (CKD) are on the rise among  people with type 1 diabetes (T1D) in the United States, according to a study published in The Journal of Clinical Endocrinology & Metabolism.

Patient records were sourced from the Geisinger Health System, which serves 40 counties in Pennsylvania. Patients with T1D (n=4060) and type 2 diabetes (T2D; n=135,458) were retrospectively reviewed for trends in obesity and kidney function between 2004 and 2018. As a comparator group, adults (n=47,611) without diabetes were assessed for trends using National Health and Nutrition Examination Survey (NHANES) data collected between 1999 and 2018.

The T1D and T2D groups were aged median 39 and 62 years, respectively, and the NHANES cohorts were aged median 43 years. In the T1D, T2D, and NHANES groups, 48.5%, 50.6%, and 51.7% were women; and 91.2%, 93.6%, and 68.6% were White, respectively. Among the same 3 groups, 66.2%, 86.8%, and 26.9% had hypertension; and 47.7%, 40.3%, and 25.8% used angiotensin-converting enzyme ACE inhibitors, respectively.

Among the T1D cohorts, metformin was the most prescribed non-insulin medication. Metformin, glucagon-like peptide-one receptor agonists (GLP-1 RA), and sodium-glucose transport protein 2 inhibitors (SGLT2) use increased over time while sulfonylureas and thiazolidinediones use decreased over the study period.

The rate of obesity in the T1D cohort increased from 32.6% in 2004 to 36.8% in 2018  (P =.0091). A similar trend of an overall increase in people with obesity was observed among the general population in the US. Obesity rates were high, and remained high, in  in people with T2D over the study period at 58.1% in 2004 and 61.6% in 2018.

Prevalence of low estimated glomerular filtration rate (eGFR) was relatively stable in the group with T1D (17.5% in 2004 to 16.1% in 2018), although this was higher than that in the general US population with T1D but lower than that of the T2D population

Low estimated glomerular filtration rate was most common among the T2D cohort (26.6%), followed by T1D (17.5%), and the general population (5.7%) in 2004. However, after adjusting for age, gender, and ethnicity, T1D, prevalence was highest in adults in the T1D study cohort.

Among the T1D cohort, low eGFR was associated with obesity (adjusted odds ratio [aOR], 1.52; 95% CI, 1.12-2.08), but was attenuated when adjusting for hypertension (aOR, 1.34; 95% CI, 0.98-1.83).Albuminuria trends were similar to low eGFR in the T1D cohort.

Obesity in T2D was associated with low eGFR (aOR, 1.27; 95% CI, 1.22-1.33) and albuminuria (aOR, 1.08; 95% CI, 1.03-1.16). Obesity was also associated with low eGFR (aOR, 1.14; 95% CI, 1.02-1.12) and albuminuria (aOR, 1.12; 95% CI, 1.02-1.22) among the general population. Researchers acknowledged the study may have been limited by the demographic features which differed between the diabetic and general population.

“Obesity, once thought to be rare in people with T1D, has reached general population prevalence” the study authors concluded. “Screening for kidney disease is not universal, yet the age-adjusted prevalence of CKD is higher in T1D than evenT2D. Strong evidence on the risks and benefits of treatments aimed at reducing obesity and protecting the kidneys in this population are needed.”

Reference

Wallace AS, Chang AR, Shin J-I, et al. Obesity and Chronic Kidney Disease in US Adults With Type 1 and Type 2 Diabetes Mellitus. J Clin Endocrinol Metab. Published January 26, 2022. doi: 10.1210/clinem/dgab927