Study Raises Alarm Over Risk of Chronic Kidney Disease, Rising Obesity Rates in Type 1 Diabetes

Elizabeth Selvin, PhD, MPH

A new study from John Hopkins University is drawing attention to the need for regular screenings as well as interventions to address obesity and chronic kidney disease among patients with type 1 diabetes.

Results of the study, which leveraged data from all patients with type 1 and type 2 diabetes in the Geisinger Health System over a 15-year period, suggests rates of obesity among patients with type 1 diabetes had were similar to that of the general population and patients with type 1 diabetes had a greater risk of kidney disease in an age-adjusted analysis.

“Our study shows that obesity rates in adults with type 1 diabetes are increasing and mirror the rates in the general adult population,” said Elizabeth Selvin, PhD, MPH, of Johns Hopkins Bloomberg School of Public Health and John Hopkins University, 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.”

Funded by the National Heart, Lung, and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases, the current study was designed by Selvin and a team of colleagues to better understand the impact of obesity and chronic kidney disease in populations with type 1 diabetes compared with patients with type 2 diabetes. Using data from the Pennsylvania-based Geisinger Health System from 2004-2018, investigators identified 4060 patients with type 1 diabetes and 135,458 patients with type 2 diabetes for inclusion in their analysis.

The primary outcomes of interest for the study included trends in obesity, low eGFR, and albuminuria. Investigators defined low eGFR as below 60 mL/min/1.73m2, and albuminuria as a urine albumin-to-creatinine ratio of 30 mg/g or more. For the purpose of analysis, investigators used multivariable logistic regression to evaluate the independent association of obesity with chronic kidney disease in 2018.

Compared to their counterparts with type 2 diabetes, patients with type 1 diabetes were younger (median age: 62 vs 39 years) and had a lower crude prevalence of low eGFR across all study years (2018: 30.6% vs 16.1%). However, after adjustment for age differences, prevalence of chronic kidney disease was greater in type 1 diabetes than type 2 diabetes in all study years (2018: 16.2% vs 9.3%).

Analysis of obesity rates suggested the rates of obesity increased over the study period among patients with type 1 diabetes, with rates increasing from 32.6% in 2004 to 36.8% in 2018. In comparison, rates of obesity remained stable in patients with type 2 diabetes throughout the study period. Additionally, results indicated a diagnosis of obesity was associated with increased odds of low eGFR in both type 1 (aOR, 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 added.

This study, “Obesity and Chronic Kidney Disease in US Adults With Type 1 and Type 2 Diabetes Mellitus,” was published in The Journal of Clinical Endocrinology & Metabolism.