Retrospective analysis on the effect of Reverse Diabetes2 Now on kidney function in patients with type 2 diabetes with impaired kidney function

Nathalie Wilmsen; Hanno Pijl; Willem Geerlings; Gerjan Navis

doi:10.1136/bmjnph-2021-000397

Retrospective analysis on the effect of Reverse Diabetes2 Now on kidney function in patients with type 2 diabetes with impaired kidney function

BMJ Nutr Prev Health. 2022 Oct 25;5(2):271-276. doi: 10.1136/bmjnph-2021-000397. eCollection 2022 Dec.

Authors

Nathalie Wilmsen¹, Hanno Pijl², Willem Geerlings¹, Gerjan Navis³

Affiliations

¹ Research & Development, Voeding Leeft, Amsterdam, The Netherlands.
² Division of Internal Medicine, Leids Universitair Medisch Centrum, Leiden, The Netherlands.
³ Division of Internal Medicine, Department of Nephrology, Academic Hospital Groningen, Groningen, The Netherlands.

Abstract

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.

Keywords: Blood pressure lowering; Diabetes mellitus; Dietary patterns; Nutritional treatment; Weight management.