408-P: Long-Term Improvement in Renal Function following Intensive Lifestyle Intervention in Patients with Diabetes and Obesity—A 15-Year Longitudinal Study

Nearly 30% of patients with diabetes mellitus (DM) develop diabetic nephropathy over time. The long-term effect of weight loss, through lifestyle intervention, on kidney function remains unknown.We evaluated 94 patients with obesity and DM (12.8% type 1 DM and 87.2% type 2 DM, age 53.9±9.9 years, diabetes duration 10.9±10.3 years, weight 108.0±18.8 kg, and BMI 38.1±5.0 kg/m2) who enrolled in a 12-week multidisciplinary intensive lifestyle intervention (ILI) conducted in real-world clinical practice. Patients were prospectively followed for over 15 years. At one year, we stratified participants according to their percentage weight loss into: group A, who maintained ≥7% weight loss (48.9%) and group B, who maintained <7% weight loss (51.1%). At 15 years, the full cohort maintained an average of 8.0±2.8 kg weight loss (10.1±19.6%, p<0.0001). Group A lost 12.8±4.1 kg (15.1±21.9%, p<0.0001) and group B lost 3.9±3.4 kg (5.5±17.6%, p=0.024). A1C did not change from baseline in group A, but increased in group B (0.6±0.5%, p=0.027). Systolic blood pressure did not change in both groups. Diastolic blood pressure decreased only in group A from 77±3 mmHg to 73±3 mmHg (p=0.03). LDL-cholesterol and HDL-cholesterol significantly improved in both groups, however, triglycerides significantly increased in both groups. Estimated glomerular filtration rate (eGFR) increased in group A from 79.5±12.5 to 92.5±15.3 mL/min/1.73 m2 (p=0.02) and in group B from 80.5±7.5 to 90.8±13.3 mL/min/1.73 m2 (p=0.02). There was no significant change in urinary albumin/creatinine ratio from baseline or serum creatinine in both groups.We conclude that 12 weeks of ILI have a sustained improvement of renal function for up to 15 years after intervention. This improvement is more pronounced in those who maintained ≥7% weight loss at one year.