Poor Glycemic Control in Type 1 Diabetes Associated with Increased CKD: Study
China: A comprehensive global analysis has highlighted that nearly one in five people living with type 1 diabetes (T1D) are affected by chronic kidney disease (CKD), underlining the growing burden of kidney complications in this population. The findings come from a systematic review and meta-analysis published in Diabetes, Obesity and Metabolism by Shuping Zhang from China Three Gorges University and colleagues.
Chronic kidney disease remains one of the most serious long-term complications of type 1 diabetes, contributing significantly to morbidity, mortality, and healthcare costs worldwide. While individual studies have reported varying prevalence estimates, a clear global picture has been lacking. To address this gap, the researchers conducted a large-scale synthesis of available evidence to estimate the worldwide prevalence of CKD among individuals with T1D and to explore factors influencing this risk.
The investigators conducted a comprehensive literature search across PubMed, Embase, the Cochrane Library, and Web of Science, spanning from database inception to 23 May 2025. Grey literature and reference lists of relevant studies were also reviewed to ensure broad coverage.
Observational studies enrolling at least 100 participants and reporting CKD prevalence in people with type 1 diabetes were eligible for inclusion. Following MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines, two independent reviewers extracted data and assessed the risk of bias. A random-effects model was used to account for variability between studies.
Key Findings:
- From 2,187 records screened, 19 studies met the inclusion criteria and were included in the final analysis.
- The pooled data covered more than 1.37 million individuals with type 1 diabetes worldwide.
- The overall global prevalence of chronic kidney disease in people with type 1 diabetes was estimated at 22.3%, indicating that over one in five are affected.
- Significant regional variation was observed, with the highest prevalence reported in the Americas (27.0%) and the lowest in Europe (19.4%).
- Adults with type 1 diabetes showed a substantially higher prevalence of CKD compared with adolescents.
- A longer duration of diabetes was associated with a greater burden of CKD, particularly among individuals with a disease duration of 10 years or more.
- Poor glycaemic control was strongly linked to higher CKD prevalence, with individuals having HbA1c levels ≥8% showing markedly higher rates than those with better control.
- Meta-regression analysis revealed a significant association between increasing HbA1c levels and the rising prevalence of CKD.
- Although high heterogeneity was noted across studies, none were assessed as having a high risk of bias.
The authors conclude that chronic kidney disease is highly prevalent among individuals with type 1 diabetes worldwide, particularly in adults, those with longer disease duration, and those with suboptimal glycaemic control. They emphasise the importance of regular kidney function screening and sustained glucose management in people with T1D to detect kidney damage early and reduce progression to severe renal disease.
Reference: https://doi.org/10.1111/dom.70378
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