- In patients with well-controlled type 2 diabetes mellitus (T2DM), the subsequent development of uncontrolled diabetes and loss of glycaemic control mediated the detrimental effect of increased adiposity on diabetic kidney disease (DKD) deterioration over time.
Why this matters
- Findings suggest that preventing worsening adiposity and hyperglycaemia is crucial to delay the future development and progression of DKD.
- This 3-year prospective study involving 853 patients with adequately controlled T2DM (HbA1c
- Funding: Singapore National Medical Research Council.
- Patients with deteriorated DKD showed a lower reduction in body composition vs those without DKD deterioration (P<.05>
- In uncontrolled diabetes, changes in adiposity were significantly associated with worsened DKD:
- Absolute changes in body weight [ΔWeight] (risk ratio [RR], 1.04; 95% CI, 1.01-1.06; P=.004),
- Absolute changes in body mass index [ΔBMI] (RR, 1.07; 95% CI, 1.01-1.13; P=.021), and
- Absolute changes in body fat mass [ΔBFM] (RR, 1.03; 95% CI, 1.01-1.06; P=.015).
- Mediation analyses showed that the risk for DKD deterioration increased with:
- uncontrolled diabetes (ΔWeight: mediation proportion [MP], 41.7% [95% CI, 0.22-1.22%]; ΔBMI: MP, 45.4% [95% CI, 0.14-1.04%]; ΔBFM: MP, 39.7% [95% CI, 0.14-0.72%]).
- poor glycaemic control (ΔWeight: MP, 15.5% [95% CI, 0.05-0.47%]; ΔBMI: MP, 14.6% [95% CI, 0.02-0.54%]; ΔBFM: MP, 16.3% [95% CI, 0.04-0.74%]).
- Only 2 measurements of the clinical and biochemical parameters were recorded.