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. 2022 Apr 19;107(5):1247-1256.
doi: 10.1210/clinem/dgab927.

Obesity and Chronic Kidney Disease in US Adults With Type 1 and Type 2 Diabetes Mellitus

Amelia S Wallace  1   2 , Alex R Chang  3   4   5 , Jung-Im Shin  1   2 , Jodie Reider  6 , Justin B Echouffo-Tcheugui  7 , Morgan E Grams  1   2   8 , Elizabeth Selvin  1   2
Affiliations

Obesity and Chronic Kidney Disease in US Adults With Type 1 and Type 2 Diabetes Mellitus

Amelia S Wallace et al. J Clin Endocrinol Metab. .

Abstract

Objective: Obesity is a global public health challenge and strongly associated with type 2 diabetes (T2D), but its burden and effects are not well understood in people with type 1 diabetes (T1D). Particularly, the link between obesity and chronic kidney disease (CKD) in T1D is poorly characterized.

Research design and methods: We included all T1D and, for comparison, T2D in the Geisinger Health System from 2004 to 2018. We evaluated trends in obesity (body mass index ≥ 30 kg/m2), low estimated glomerular filtration rate (eGFR) (≤60 mL/min/1.73m2), and albuminuria (urine albumin-to-creatinine ratio ≥ 30 mg/g). We used multivariable logistic regression to evaluate the independent association of obesity with CKD in 2018.

Results: People with T1D were younger than T2D (median age 39 vs 62 years). Obesity increased in T1D over time (32.6% in 2004 to 36.8% in 2018), while obesity in T2D was stable at ~60%. The crude prevalence of low eGFR was higher in T2D than in T1D in all years (eg, 30.6% vs 16.1% in 2018), but after adjusting for age differences, prevalence was higher in T1D than T2D in all years (eg, 16.2% vs 9.3% in 2018). Obesity was associated with increased odds of low eGFR in T1D [adjusted odds ratio (AOR) = 1.52, 95% CI 1.12-2.08] and T2D (AOR = 1.29, 95% CI 1.23-1.35).

Conclusions: Obesity is increasing in people with T1D and is associated with increased risk of CKD. After accounting for age, the burden of CKD in T1D exceeded the burden in T2D, suggesting the need for increased vigilance and assessment of kidney-protective medications in T1D.

Keywords: aging; epidemiology; nephropathy; obesity; type 1 diabetes; type 2 diabetes.

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Figures

Figure 1.
Figure 1.
Flow diagram of diabetes algorithm.
Figure 2.
Figure 2.
Trends in prescriptions for major classes of antidiabetes medications in adults with type 1 diabetes—Geisinger Health System, 2004-2018.
Figure 3.
Figure 3.
Trends in prescriptions for major classes of antidiabetes medications in adults with type 2 diabetes—Geisinger Health System, 2004-2018.
Figure 4.
Figure 4.
Unadjusted and adjusted prevalence of obesity (A and D), reduced estimated glomerular filtration rate (B and E), and elevated albumin-to-creatinine ratio (C and F) in adults with type 1 diabetes, type 2 diabetes, and a nondiabetic general population.
Figure 5.
Figure 5.
Distributions of estimated glomerular filtration rate (A) and albumin-to-creatinine ratio (B) in adults with type 1 diabetes, type 2 diabetes, and a nondiabetic general population.
Figure 6.
Figure 6.
Biennial kidney function screening rates for people with type 1 diabetes and type 2 diabetes—estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR) (A), eGFR (B), and ACR (C).
See this image and copyright information in PMC

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