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Retrospective analysis on the effect of Reverse Diabetes2 Now on kidney function in patients with type 2 diabetes
Nathalie Wilmsen1, Hanno Pijl2, Willem Geerlings1
1Research & Development, Voeding Leeft, Amsterdam, The Netherlands.
Objective:
Type 2 diabetes is one of the main causes of kidney damage. Recent intervention studies suggest that the progression of type 2 diabetes can be halted, or even brought into remission by lifestyle interventions. In a pragmatic trial, the Reverse Diabetes2 Now programme (RD2N, NL: Keer Diabetes2 Om), a multicomponent lifestyle intervention, reduced the need for bloodglucose lowering medications up to 24 months.
Research Design And Methods:
Here, we retrospectively investigate the effect of RD2N on markers of kidney function in patients selected for impaired kidney function at baseline (eGFR <70 mL/min/1.73 m2 (n=45). Baseline data were retrieved from the intervention database and follow-up data on renal markers were collected from routine medical records. Wilcoxon non-parametric tests were used to assess changes over 6 and 12 months.
Results:
After 6 months median eGFR increased significantly from 62.0 (IQR 55.5-65.0) to 69.0 (IQR 55.0-76.5) mL/min/1.73 m2 (p=0.002). Median albumin/creatinine ratio (n=26) remained within the normal range (<3 mg/mmol). The effect on eGFR was similar after exclusion of patients in whom medication was changed (median eGFR 62.0 ((IQR 59.5-66.0) to 69.0 (IQR 60.0-77.0) mL/min/1.73 m2, p=0.006, n=29), suggesting that the effect on eGFR is not related to medication changes. At 12 months, eGFR was not significantly changed (n=22, median eGFR 63.5 mL/min/1.73 m2 (IQR 58.5-71.0), p=0.067).
Conclusions:
The retrospective nature of this study and the despite guidelines limited availability of renal markers in routine type 2 diabetes care are limiting. Nevertheless, these data support a favourable effect of RD2N on renal function. Further research, with proper documentation of renal function, urinary protein excretion and dietary intake, is needed to substantiate these results, ideally in a large-scale prospective cohort study.
Insights
Lifestyle interventions like the Reverse Diabetes2 Now (RD2N) program can improve kidney function in type 2 diabetes patients. This study showed a significant increase in estimated glomerular filtration rate (eGFR) after 6 months of the RD2N intervention.
Area of Science:
- Nephrology
- Endocrinology
- Public Health
Background:
- Type 2 diabetes is a leading cause of chronic kidney disease.
- Lifestyle interventions show promise in halting or reversing type 2 diabetes progression.
- The Reverse Diabetes2 Now (RD2N) program is a multicomponent lifestyle intervention.
Purpose of the Study:
- To retrospectively investigate the effect of the RD2N lifestyle intervention on kidney function markers in type 2 diabetes patients with impaired kidney function at baseline.
- To assess changes in estimated glomerular filtration rate (eGFR) and albumin/creatinine ratio over 6 and 12 months.
Main Methods:
- Retrospective analysis of data from 45 type 2 diabetes patients with baseline eGFR <70 mL/min/1.73 m².
- Data collected from the RD2N intervention database and routine medical records.
- Non-parametric Wilcoxon tests used to analyze changes in renal markers at 6 and 12 months.
Main Results:
- Median eGFR significantly increased from 62.0 to 69.0 mL/min/1.73 m² after 6 months (p=0.002).
- The increase in eGFR was independent of medication changes.
- Median albumin/creatinine ratio remained within normal limits; eGFR did not significantly change at 12 months.
Conclusions:
- The RD2N lifestyle intervention demonstrates a favorable effect on renal function in type 2 diabetes patients with impaired kidney function.
- Limitations include the retrospective design and limited availability of renal markers in routine care.
- Further prospective research with detailed documentation is recommended to confirm these findings.
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