Are we ready for an adipocentric approach in people living with type 2 diabetes and chronic kidney disease?

Author:

Moreno-Pérez Oscar12ORCID,Reyes-García Rebeca34ORCID,Modrego-Pardo Inés5ORCID,López-Martínez Marina6ORCID,Soler María José6ORCID

Affiliation:

1. Department of Endocrinology and Nutrition, General University Hospital Dr Balmis of Alicante, Institute of Health and Biomedical Research of Alicante (ISABIAL), Alicante , Alicante, Spain

2. Department of Clinical Medicine, Miguel Hernández University , San Juan, Alicante , Spain

3. Endocrinology Unit, University Hospital of Torrecárdenas , Almería, Almería, Spain ; CIBER de Fragilidad y Envejecimiento Saludable “CIBERFES”,

4. Instituto de Salud Carlos III , Almería, Almería, Spain ; CIBER de Fragilidad y Envejecimiento Saludable “CIBERFES”,

5. Department of Endocrinology and Nutrition, University Hospital Marina Baixa, Villajoyosa , Alicante, Spain

6. Department of Nephrology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research , Barcelona , Spain ; Centro de Referencia en Enfermedad, Glomerular Compleja del Sistema Nacional de Salud de España (CSUR), Barcelona , Spain . GEENDIAB, RICORS2024

Abstract

ABSTRACT We are entering a new era in the management of adiposity-based chronic disease (ABCD) with type 2 diabetes (T2D) and related chronic kidney disease (CKD). ABCD, T2D and CKD can affect almost every major organ system and have a particularly strong impact on the incidence of cardiovascular disease (CVD) and heart failure. ABCD and the associated insulin resistance are at the root of many cardiovascular, renal and metabolic (CKM) disorders, thus an integrated therapeutic framework using weight loss (WL) as a disease-modifying intervention could simplify the therapeutic approach at different stages across the lifespan. The breakthrough of highly effective WL drugs makes achieving a WL of >10% possible, which is required for a potential T2D disease remission as well as for prevention of microvascular disease, CKD, CVD events and overall mortality. The aim of this review is to discuss the link between adiposity and CKM conditions as well as placing weight management at the centre of the holistic CKM syndrome approach with a focus on CKD. We propose the clinical translation of the available evidence into a transformative Dysfunctional Adipose Tissue Approach (DATA) for people living with ABCD, T2D and CKD. This model is based on the interplay of four essential elements (i.e. adipocentric approach and target organ protection, dysfunctional adiposity, glucose homeostasis, and lifestyle intervention and de-prescription) together with a multidisciplinary person-centred care. DATA could facilitate decision-making for all clinicians involved in the management of these individuals, and if we do this in a multidisciplinary way, we are prepared to meet the adipocentric challenge.

Publisher

Oxford University Press (OUP)

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