Obesity and kidney disease in type 1 and 2 diabetes: An analysis of the National Diabetes Audit

Abstract

Background: Obesity is increasingly prevalent in many countries. Obesity is amajor risk factor for the development of type 2 diabetes but its relationship withdiabetic kidney disease (DKD) remains unclear. Some studies have suggested that the metabolic syndrome (including obesity) may be associated with DKD in type 1 diabetes. Aim: To investigate the association between obesity and DKD. Design: Retrospective cross-sectional study. Methods: National Diabetes Audit data were availablefor the 2007-08 cycle. Type 1 and 2 diabetes patients with both a valid serum creatinine and urinary albumin:creatinine ratio were included. DKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2, albuminuria or both.Logistic regression was used to analyse associations of obesity (body mass index 530 kg/m2) and other variables including year of birth, year of diagnosis, ethnicity and stage of kidney disease. Results: A total of 58 791 type 1 and 733 769 type 2 diabetes patients were included in the analysis. After adjustment, when comparedwith type 1 diabetes patients with normal renal function those with DKD were up totwice as likely to be obese. Type 2 DKD patients were also more likely to be obese.For example, type 2 diabetes patients with an eGFR <15 ml/min/1.73m2 and normoalbuminuria, microalbuminuria or macroalbuminuria were all more likely to be obese; odds ratios (95% CI) 1.65 (1.3-2.1), 1.56 (1.28-1.92) and 1.27 (1.05-1.54), respectively. Conclusions: This study has highlighted a strong association between obesity and kidney disease in type 1 diabetes and confirmed their association in type 2 diabetes. © The Author 2013. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.