麻豆传媒

Obesity and chronic kidney disease (CKD) are increasingly becoming a burden for people with type 1 diabetes, a new study suggested.

Although both conditions are typically thought of as associated with type 2 diabetes, the rates have increased among the type 1 diabetes population from 2004 to 2018, reported Elizabeth Selvin, PhD, MPH, of Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues.

More specifically, the prevalence of obesity among those with type 1 diabetes increased from 32.6% in 2004 to 36.8% in 2018. On the other hand, the rates of obesity remained stable -- holding at roughly 60% -- in the type 2 diabetes population during this time, the researchers wrote in the .

And as for CKD, the prevalence of low estimated glomerular filtration rate (eGFR) -- under 60 mL/min/1.73m² -- was actually higher in individuals with type 1 diabetes versus type 2 diabetes in a model adjusted for age. For example, in 2018 the adjusted burden of CKD among those with type 1 diabetes was 16.2% compared with 9.3% for the type 2 diabetes population.

As expected, obesity was tied to a higher odds of having a low eGFR in both diabetes types. In adjusted models, obesity was linked with a 52% (adjusted odds ratio 1.52, 95% CI 1.12-2.08) and a 29% (aOR 1.29, 95% CI 1.23-1.35) increased chance of having a low eGFR in people with type 1 diabetes and type 2 diabetes, respectively.

"Our study shows that obesity rates in adults with type 1 diabetes are increasing and mirror the rates in the general adult population," Selvin explained in a statement. "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."

"Our results highlight the need for interventions to prevent weight gain and end-stage kidney disease in people with type 1 diabetes," she added.

That being said, the researchers pointed out that the current clinical guidelines suggest annual screening for CKD in those with type 1 or type 2 diabetes, but some evidence has suggested that these recommendations aren't consistently adhered to in a real-world clinical setting.

"In our study, fewer than half of people with T2D [type 2 diabetes] had both markers measured, even over a 2-year period. eGFR was checked more frequently overall, and although [albumin-to-creatinine ratio] was checked less frequently, it was more commonly tested in people with T1D [type 1 diabetes] than T2D," the team explained.

"Overall, CKD awareness in the United States is low, even among those at high risk or advanced stages of CKD," the researchers added.

Selvin's group drew upon data from the Geisinger Health System, which included adults ages 18 and older with type 1 or type 2 diabetes receiving primary care at Geisinger between 2004 and 2018. The final cohort included 4,060 patients with type 1 diabetes and 135,458 patients with type 2 diabetes.

Those with type 1 diabetes tended to be younger than the general population, but also much younger than the type 2 diabetes population: median ages of 39, 43, and 62, respectively. The diabetes population also had a higher proportion of white individuals compared with the general population. As for comorbidities, hypertension was far more common among those with diabetes than the general population, as well (66.2% of T1D, 86.8% of T2D, 26.9% of general population).

One limitation of the study, the researchers said, was the generally non-Hispanic white patient population of central Pennsylvania.

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