Weight change and microvascular outcomes in patients with new-onset diabetes: a nationwide cohort study
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: Because weight control is important in treatment of type 2 diabetes, it is essential to understand the associations between weight change and the risk of microvascular complications among patients with type 2 diabetes. We examined whether weight changes early after new-onset diabetes have an impact on the clinical outcomes of diabetic nephropathy and retinopathy. Methods: Using the Korean National Health Insurance Service-National Health Screening Cohort database, 181,872 patients newly diagnosed with type 2 diabetes who were free of end-stage renal disease (ESRD) and proliferative diabetic retinopathy (PDR) during 2007 to 2012 were followed to the end of 2016. Weight change was defined as the difference in body weight from the time of diabetes diagnosis to 2 years later. Results: We identified 180 cases of ESRD and 780 cases of PDR followed up for a median of 5.5 years from the index year at 2 years after diagnosis. Those with 5% to 10% weight gain showed a significantly higher hazard ratio (HR) for ESRD, compared with those with ≤ 5% weight change after adjusting for several confounding factors, including the baseline estimated glomerular filtration rate (HR, 1.75; 95% confidence interval [CI], 1.14 to 2.70). Those with ≥ 10% weight loss showed the lowest HR for PDR (HR, 0.52; 95% CI, 0.33 to 0.83), whereas those with ≥ 10% weight gain showed the highest HR for PDR (HR, 3.20; 95% CI, 2.51 to 4.08). Conclusions: Weight gain after new-onset diabetes was associated with increased risk of ESRD and PDR whereas weight loss with decreased risk of PDR, but not ESRD.
Abstract
Background/Aims: Because weight control is important in treatment of type 2 diabetes, it is essential to understand the associations between weight change and the risk of microvascular complications among patients with type 2 diabetes. We examined whether weight changes early after new-onset diabetes have an impact on the clinical outcomes of diabetic nephropathy and retinopathy. Methods: Using the Korean National Health Insurance Service-National Health Screening Cohort database, 181,872 patients newly diagnosed with type 2 diabetes who were free of end-stage renal disease (ESRD) and proliferative diabetic retinopathy (PDR) during 2007 to 2012 were followed to the end of 2016. Weight change was defined as the difference in body weight from the time of diabetes diagnosis to 2 years later. Results: We identified 180 cases of ESRD and 780 cases of PDR followed up for a median of 5.5 years from the index year at 2 years after diagnosis. Those with 5% to 10% weight gain showed a significantly higher hazard ratio (HR) for ESRD, compared with those with ≤ 5% weight change after adjusting for several confounding factors, including the baseline estimated glomerular filtration rate (HR, 1.75; 95% confidence interval [CI], 1.14 to 2.70). Those with ≥ 10% weight loss showed the lowest HR for PDR (HR, 0.52; 95% CI, 0.33 to 0.83), whereas those with ≥ 10% weight gain showed the highest HR for PDR (HR, 3.20; 95% CI, 2.51 to 4.08). Conclusions: Weight gain after new-onset diabetes was associated with increased risk of ESRD and PDR whereas weight loss with decreased risk of PDR, but not ESRD.
참고문헌 (40)
- Dow C, "Diet and risk of diabetic retinopathy : a systematic review", Eur J Epidemiol, 33, pp.141~156 (2018)
- Rubsam A, "Role of inflammation in diabetic retinopathy", Int J Mol Sci, 19, pp.942~ (2018)
- NCD Risk Factor Collaboration (NCD-RisC), "Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants", Lancet, 387, pp.1513~1530 (2016)
- Hammes HP, "Diabetic retinopathy : hyperglycaemia, oxidative stress and beyond", Diabetologia, 61, pp.29~38 (2018)
- Zhang X, "Diabetic retinopathy : reversibility of epigenetic modifications and new therapeutic targets", Cell Biosci, 7, pp.42~ (2017)
- Reidy K, "Molecular mechanisms of diabetic kidney disease", J Clin Invest, 124, pp.2333~2340 (2014)
- Hsieh YT, "Association of abnormal renal profiles and proliferative diabetic retinopathy and diabetic macular edema in an Asian population with type 2 diabetes", JAMA Ophthalmol, 136, pp.68~74 (2018)
- Hwang HS, "Diabetes retinopathy is a poor predictor for renal and cardiovascular outcomes in comparison with hypertensive retinopathy in patients with chronic kidney disease", Diabetes Res Clin Pract, 109, pp.312~318 (2015)
- Lee MK, "Normal-to-mildly increased albuminuria predicts the risk for diabetic retinopathy in patients with type 2 diabetes", Sci Rep, 7, pp.11757~ (2017)
- Kyung-Jin Yun, "Risk Factors for the Development and Progression of Diabetic Kidney Disease in Patients with Type 2 Diabetes Mellitus and Advanced Diabetic Retinopathy", Diabetes and Metabolism Journal, 40(6), pp.473~481 (2016), 대한당뇨병학회[DOI]
- Mallamaci F, "Obesity and CKD progression : hard facts on fat CKD patients", Nephrol Dial Transplant, 28(Suppl 4), pp.iv105~iv108 (2013)
- Satriano J, "Autophagy and metabolic changes in obesity-related chronic kidney disease", Nephrol Dial Transplant, 28(Suppl 4), pp.iv29~iv36 (2013)
- Kubota T, "Imbalanced insulin actions in obesity and type 2 diabetes : key mouse models of insulin signaling pathway", Cell Metab, 25, pp.797~810 (2017)
- Ikizler TA, "Metabolic effects of diet and exercise in patients with moderate to severe CKD : a randomized clinical trial", J Am Soc Nephrol, 29, pp.250~259 (2018)
- Bolignano D, "Effects of weight loss on renal function in obese CKD patients : a systematic review", Nephrol Dial Transplant, 28(Suppl 4), pp.iv82~iv98 (2013)
- 고승현, "Past and Current Status of Adult Type 2 Diabetes Mellitus Management in Korea: A National Health Insurance Service Database Analysis", Diabetes and Metabolism Journal, 42(2), pp.93~100 (2018), 대한당뇨병학회[DOI]
- Kim MK, "Weight change and mortality and cardiovascular outcomes in patients with new-onset diabetes mellitus : a nationwide cohort study", Cardiovasc Diabetol, 18, pp.36~ (2019)
- Nam GE, "BMI, weight change, and dementia risk in patients with new-onset type 2 diabetes : a nationwide cohort study", Diabetes Care, 42, pp.1217~1224 (2019)
- Koh ES, "Intra-individual variability in high density lipoprotein cholesterol and risk of endstage renal disease : a nationwide population-based study", Atherosclerosis, 286, pp.135~141 (2019)
- Kim MK, "Variability in total cholesterol is associated with the risk of end-stage renal disease : a nationwide population-based study", Arterioscler Thromb Vasc Biol, 37, pp.1963~1970 (2017)
- Kovesdy CP, "Obesity and kidney disease : hidden consequences of the epidemic", Am J Nephrol, 45, pp.283~291 (2017)
- Stenvinkel P, "Obesity in CKD:what should nephrologists know?", J Am Soc Nephrol, 24, pp.1727~1736 (2013)
- Garofalo C, "A systematic review and meta-analysis suggests obesity predicts onset of chronic kidney disease in the general population", Kidney Int, 91, pp.1224~1235 (2017)
- Jung CH, "The risk of chronic kidney disease in a metabolically healthy obese population", Kidney Int, 88, pp.843~850 (2015)
- Iseki K, "Body mass index and the risk of development of endstage renal disease in a screened cohort", Kidney Int, 65, pp.1870~1876 (2004)
- Hsu CY, "Body mass index and risk for end-stage renal disease", Ann Intern Med, 144, pp.21~28 (2006)
- Look AHEAD Research Group, "Effect of a long-term behavioural weight loss intervention on nephropathy in overweight or obese adults with type 2 diabetes : a secondary analysis of the Look AHEAD randomised clinical trial", Lancet Diabetes Endocrinol, 2, pp.801~809 (2014)
- Chang AR, "Bariatric surgery is associated with improvement in kidney outcomes", Kidney Int, 90, pp.164~171 (2016)
- Whaley-Connell A, "Obesity and kidney disease : from population to basic science and the search for new therapeutic targets", Kidney Int, 92, pp.313~323 (2017)
- Ikizler TA, "A patient with CKD and poor nutritional status", Clin J Am Soc Nephrol, 8, pp.2174~2182 (2013)
- Kalantar-Zadeh K, "The obesity paradox in kidney disease : how to reconcile it with obesity management", Kidney Int Rep, 2, pp.271~281 (2017)
- Naderi N, "Obesity paradox in advanced kidney disease : from bedside to the bench", Prog Cardiovasc Dis, 61, pp.168~181 (2018)
- Moh A, "Excess visceral adiposity is associated with diabetic retinopathy in a multiethnic Asian cohort with longstanding type 2 diabetes", Endocr Res, 43, pp.186~194 (2018)
- Yoshida Y, "Risk factors for the development of diabetic retinopathy in Japanese type 2 diabetic patients", Diabetes Res Clin Pract, 51, pp.195~203 (2001)
- Chan JC, "Differential effect of body mass index on the incidence of diabetes and diabetic retinopathy in two Asian populations", Nutr Diabetes, 8, pp.16~ (2018)
- Van Leiden HA, "Blood pressure, lipids, and obesity are associated with retinopathy : the Hoorn Study", Diabetes Care, 25, pp.1320~1325 (2002)
- Jeng CJ, "Diabetic retinopathy in patients with diabetic nephropathy : development and progression", PLoS One, 11, pp.e0161897~ (2016)
- Rodriguez-Poncelas A, "Chronic kidney disease and diabetic retinopathy in patients with type 2 diabetes", PLoS One, 11, pp.e0149448~ (2016)
- Han Q, "Non-genetic mechanisms of diabetic nephropathy", Front Med, 11, pp.319~332 (2017)
- Willermain F, "Potential interplay between hyperosmolarity and inflammation on retinal pigmented epithelium in pathogenesis of diabetic retinopathy", Int J Mol Sci, 19, pp.1056~ (2018)