Abstract
We previously reported that, in patients with diabetes, intensive lifestyle intervention (ILI) in real-world clinical practice could lead to significant weight loss that was attainable for up to 10 yrs and had favorable impact on glycemic control and lipid profile. These improvements were predicted by achieving ≥7% weight loss at 1 yr. In this secondary analysis, we investigated whether initial weight loss at 1 yr is associated with incidence of nephropathy over 10 yrs. This analysis included 128 patients with diabetes enrolled in a 12-wk ILI (age 53.7±10.1 yrs; 66.4% females; duration of diabetes 9.6±9.4 yrs; body mass index [BMI] 38.3±5.3 kg/m2; and 9.3% had type 1 diabetes). At 1 yr, we divided participants into 2 groups: group A (n=61, 47.7%) maintained <7% weight loss and group B (n=67, 52.3%) maintained ≥7% weight loss. Data on incidence of nephropathy were collected from electronic health records over 10 yrs of follow-up. Cox proportional hazard models were used to calculate hazard ratios after dichotomizing the incidence of nephropathy. After a median of 10 yrs of follow-up, the incidence rate of nephropathy in group A was 3.58 cases per 100 person-years vs. 1.42 cases per 100 person-years in group B (difference 2.16 cases per 100 person-years, sex-adjusted hazard ratio for group B: 0.33, 95% CI: 0.12, 0.94, p=0.039). Moreover, in a multivariable model fitted with terms for age, diabetes type, diabetes duration, BMI, plus group assignment and sex, the group-effect retained independent significance (fully adjusted hazard ratio for group B: 0.32, 95% CI: 0.11, 0.9, p= 0.007). We conclude that adult patients with diabetes who maintained ≥7% weight loss at 1yr after the initial ILI had a 68% lower risk of nephropathy for up to 10 yrs. These data support the essential role of weight reduction in preventing or delaying the progression of chronic kidney disease in patients with diabetes and overweight or obesity. Disclosure S. Tomah: Stock/Shareholder; Self; Amarin Corporation plc. H. Zhang: None. H. Gardner: None. M. Al-badri: None. O. Hamdy: Advisory Panel; Self; Nestlé, Consultant; Self; Abbott, AstraZeneca, Sanofi, Research Support; Self; Eli Lilly and Company, Gilead Sciences, Inc., National Dairy Council, Novo Nordisk, Stock/Shareholder; Self; Healthimation, LLC.
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