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"Weight gain and central obesity are associated with insulin resistance,
hypertension, and dyslipidemia in type 1 diabetes," write Ian H. de Boer,
MD, of the University of Washington in Seattle, and colleagues from the Diabetes
Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications
Study Research Group. "These metabolic abnormalities are risk factors for
kidney disease in the general population, but data addressing the relationship
of central obesity with kidney disease in type 1 diabetes are limited."
To determine whether waist circumference is associated with incident microalbuminuria
and change in creatinine clearance, the investigators evaluated 1279 participants
with type 1 diabetes who were enrolled in the Epidemiology of Diabetes Interventions
and Complications Study, the observational extension of the Diabetes Control
and Complications Trial (DCCT).
During 5.8 years of follow-up, 93 of 1105 participants with normal albumin
excretion rate (AER) at DCCT closeout developed incident microalbuminuria. After
adjustment for DCCT closeout age, sex, duration of diabetes, treatment group,
smoking status, glycated hemoglobin (HbA1c), and AER, the hazard ratio (HR)
for incident microalbuminuria that was associated with each 10-cm greater waist
circumference at DCCT closeout was 1.34 (95% confidence interval [CI], 1.07
- 1.68).
After additional adjustment for levels of blood pressure and serum lipids,
this increased risk was modestly attenuated. Creatinine clearance decreased
by an average of 0.34 mL/minute per 1.73 m2 per year during 8 years of follow-up.
Faster rate of decrease in creatinine clearance was associated with increased
age, conventional insulin therapy during the DCCT, smoking, and greater HbA1c
level and AER at DCCT closeout, but not with waist circumference.
"Waist circumference predicts the subsequent development of microalbuminuria
in type 1 diabetes," the authors write. "In contrast, no association
was observed between waist circumference and change in creatinine clearance
over time, further suggesting that microalbuminuria and loss of excretory kidney
function may have different risk factors and pathogenic mechanisms in this population."
J Am Soc Nephrol. 2007;18:235-243.
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