Baltimore, MD—Conventional wisdom for pharmacists and other healthcare professionals has always been that obesity is an issue for patients with T2D but less so for those diagnosed with T1D.

A new study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism suggests otherwise, however, and advises that those with T1D should be screened regularly for obesity and CKD.

"Our study shows that obesity rates in adults with type 1 diabetes are increasing and mirror the rates in the general adult population," explained corresponding author Elizabeth Selvin, PhD, MPH, Johns Hopkins Bloomberg School of Public Health and John Hopkins University in Baltimore. "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 had a higher risk of kidney disease than those with type 2."

The study points out that while obesity is a global public health challenge and "strongly associated with type 2 diabetes (T2D), its burden and effects are not well understood in people with type 1 diabetes (T1D). Particularly, the link between obesity and CKD in T1D is poorly characterized."

To remedy that, the study team included all 4,060 T1D patients—and, for comparison, 135,458 T2D patients—in the Geisinger Health System in Pennsylvania from 2004 to 2018. The goal was to evaluate 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).

Among a younger cohort with T1D (median age 39 years vs. 62 years), researchers found that obesity increased in T1D over time (32.6% in 2004 to 36.8% in 2018), while obesity in T2D was stable at about 60%.

In addition, the study determined that the crude prevalence of low eGFR was higher in T2D than in T1D in all years (e.g., 30.6% vs. 16.1% in 2018). After adjusting for age differences, however, they found that prevalence was higher in T1D than T2D in all years (e.g., 16.2% vs. 9.3% in 2018). The study also noted that 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).

"Obesity is increasing in people with T1D and is associated with increased risk of CKD," the authors conclude. "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."

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

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