This study used data from a large healthcare system serving 40 counties in Pennsylvania, US, to evaluate the prevalence of obesity and chronic kidney disease (CKD) in people with type 1 and type 2 diabetes. Data were also compared with people from the general US population in the NHANES (National Health and Nutrition Examination Survey).
Data from 4060 people with type 1 diabetes and 135 458 with type 2 diabetes were analysed. People with type 1 diabetes were younger than the general population and much younger than the type 2 cohort (median age, 39 vs 43 vs 62 years). The prevalence of obesity in the type 1 cohort increased between 2004 and 2018 and was level with the general population in 2018, at 36.8%. Obesity was more common in the type 2 cohort, with a prevalence of 61.6% in 2018.
The crude prevalence of reduced eGFR (<60 mL/min/1.73 m2) was higher in the type 1 cohort than in the general population, but lower than in the type 2 cohort (17.5% vs 5.7% vs 26.6%). However, after adjustment for age, sex and race, the prevalence was highest in the type 1 cohort, at around 17% compared with 9% in the type 2 cohort and 1% in the general population. Albuminuria (ACR ≥30 mg/g) followed a similar trend, with the highest crude levels in the type 2 cohort but highest adjusted levels in the type 1 cohort.
The distribution of eGFR in the people with type 1 diabetes was skewed toward lower values, indicating relatively high prevalence of early kidney dysfunction despite the young age of the cohort. In that group, obesity was associated with a 52% increased risk of low eGFR after adjustment for age, sex and race, while albuminuria risk was 35% higher.
The authors conclude that obesity, previously thought to be less common in people with type 1 diabetes, has reached a similar prevalence to the general population in the US. It is also associated with a disproportionately high risk of chronic kidney disease.
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