Association between metabolic phenotype and diabetic kidney disease in adult-onset type 1 diabetes patients from China: A multi-center cross-sectional study

Jun Jiang; Peng Wang; Jielong Jiang; Tingmin Zhang; Yu Ding; Xueying Zheng; Sihui Luo; Jinhua Yan; Kuanxiao Tang; Daizhi Yang

doi:10.1016/j.diabres.2025.112347

Association between metabolic phenotype and diabetic kidney disease in adult-onset type 1 diabetes patients from China: A multi-center cross-sectional study

Diabetes Res Clin Pract. 2025 Jun 25:112347. doi: 10.1016/j.diabres.2025.112347. Online ahead of print.

Authors

Jun Jiang¹, Peng Wang², Jielong Jiang², Tingmin Zhang², Yu Ding³, Xueying Zheng³, Sihui Luo³, Jinhua Yan⁴, Kuanxiao Tang⁵, Daizhi Yang⁶

Affiliations

¹ Department of Nephrology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China; Institute of Endocrine and Metabolic Diseases, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China.
² Department of Nephrology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China.
³ Institute of Endocrine and Metabolic Diseases, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China.
⁴ Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, Guangdong, China.
⁵ Department of General Practice, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China. Electronic address: tkx610@hotmail.com.
⁶ Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, Guangdong, China. Electronic address: yangdzh3@mail.sysu.

PMID: 40578520
DOI: 10.1016/j.diabres.2025.112347

Abstract

Aim: To explore the association of different metabolic phenotypes with diabetic kidney disease (DKD) and high DKD progression risk in adult-onset type 1 diabetes mellitus (T1DM) patients from China.

Methods: According to body mass index (BMI) and metabolic risk factors, the patients were divided into six metabolic phenotypes. The proportions of metabolic phenotypes were investigated. Logistic regression models were used to explore the association of different metabolic phenotypes with DKD and high DKD progression risk in adult-onset T1DM patients, and the odds ratio (OR) and 95 % confidence interval (CI) of each metabolic phenotype were calculated.

Results: In 433 adult-onset T1DM patients, Phenotype 4 (T1DM with underweight metabolically unhealthy phenotype) (OR = 1.86, 95 % CI:1.35---2.57, P < 0.001) was correlated with moderate albuminuria, while phenotype 3 (T1DM with overweight metabolically healthy phenotype) (OR = 1.84, 95 % CI:1.03-3.28, P = 0.04) and phenotype 4 (OR = 1.73, 95 % CI:1.13-2.67, P = 0.01) both had an independent positive correlation with abnormal kidney function. Phenotype 4 (OR = 45.14, 95 % CI:7.69-264.95, P < 0.001) and phenotype 5 (T1DM with normal weight metabolically unhealthy phenotype) (OR = 5.59, 95 % CI:1.10-28.34, P = 0.038) both had an independent positive association with the high risk of DKD progression.

Conclusion: In adult-onset T1DM patients, the T1DM with underweight metabolically unhealthy phenotype was associated with moderate albuminuria, abnormal kidney function, and high risk of DKD progression. These findings suggest that underweight with metabolic abnormalities was a risk factor for DKD and DKD progression.

Keywords: Diabetic kidney disease; Metabolic phenotype; Type 1 diabetes mellitus.