The effect of intensive lifestyle intervention on renal function in patients with diabetes and obesity in real-world practice: A 5-years longitudinal study

Abstract

Aim: This study was designed to investigate the long-term effects of intensive lifestyle intervention (ILI) and weight loss (WL) on renal function in patients with DM and obesity in real-world clinical practice. Method: We evaluated 104 patients with obesity and type 1 (13.4%) or type 2 DM (86.6%) with a mean age of 53.8 ± 10.0 years and mean diabetes duration of 10.7 ± 9.8 years who enrolled in a 12-week ILI program. We stratified participants according to WL at one year into: group A, maintained ≥7% WL (49.1%) and group B, maintained <7% WL (50.9%) and prospectively followed them for 5 years. Results: At 5 years, group A had lost, on average, 8.3 ± 11.5 kg (7.5 ± 10.1%, p < 0.01) and group B had lost 4.2 ± 9.9 kg (3.4 ± 8.4%, p < 0.01). HbA1c decreased in group A by 0.3 ± 0.9% (p < 0.001) and increased in group B by 0.9 ± 1.8% (p < 0.001). Systolic blood pressure (SBP) improved in both groups but the change was only statistically significant in group B from 128.6 ± 14.3 mmHg to 121.4 ± 15.4 mmHg (p < 0.05). Serum creatinine decreased in group A from 0.92 ± 0.19 mg/dL to 0.85 ± 0.23 mg/dL (p < 0.01) and in group B from 0.92 ± 0.21 mg/dL to 0.84 ± 0.26 mg/dL (p < 0.01). eGFR increased in group A from 86.0 ± 28.4 mL/min/1.73 m2 to 97.7 ± 37.7 mL/min/1.73 m2 (p < 0.001) and in group B from 84.3 ± 24.9 mL/min/1.73 m2 to 97.2 ± 37.4 mL/min/1.73 m2 (p < 0.01). Urinary albumin/creatinine ratio did not change from baseline in either group. Conclusion: A12 week period of ILI for improves eGFR and serum creatinine for the subsequent 5 years irrespective of maintenance of weight loss, weight regain, or changes in HbA1c and SBP.

Keywords

• Diabetes
• Weight management
• Lifestyle intervention(s)
• Renal function