A study assessing the long-term kidney health of people with type 1 diabetes (T1D) reveals several factors associated with a sharp decline in kidney function. The factors include poor glycemic control resulting in high blood sugar, being overweight or obese, albuminuria (the presence of the protein albumin in the urine), and high blood pressure. Of note, women with a high body mass index (BMI) - and especially those classified as obese - were at particularly high risk of experiencing sharp kidney function decline and kidney disease.
Dr. Kristen Favel is a researcher at the University of San Francisco, who helped lead the study while completing a fellowship at BC Children’s Hospital in Vancouver, BC between 2018 and 2022. “We were interested in breaking down and understanding the longitudinal trajectories of kidney function over time for patients with type 1 diabetes,” Favel explains.
In their study, published in the Journal of Diabetes and Its Complications, Favel and colleagues analyzed data from more than 300 people diagnosed with T1D between 1996 and 2020. They followed each patient for an average of three years, and looked at factors such as blood pressure, kidney function, albumin-to-creatinine ratio and BMI, among others.
The results show four distinct trajectories for kidney function over time, with two groups of patients who experienced sharp declines earlier in life, and two groups who experienced gradual decline.
The first category of T1D patients with steep kidney function decline tended to have poorer glycemic control, higher grade albuminuria, and BMIs in the overweight range. The second category of T1D patients with steep decline were diagnosed with diabetes at a young age, more likely to be female, and had BMIs in the obese range. Strikingly, females were three times as likely to experience sharp declines in kidney function compared to males, who were more likely to experience gradual declines.
Favel says she was surprised at the particularly strong influence high BMI had on kidney health. Although only 8 percent of people in the study were overweight or obese, these patients made up nearly 50 percent of the people who experienced sharp declines in kidney function.
“These findings highlight the importance, not only of closely monitoring blood sugar levels, optimizing blood pressure, and treating albuminuria, but also increasing resources to prevent and address obesity,” Favel says.
She adds that after this study, the team at BC Children’s Hospital created educational materials for patients and their families, explaining why tests for kidney function are important if you have T1D.
Study:
Classification of longitudinal estimated glomerular filtration rate trajectories in Canadian adults with type 1 diabetes
