Development and Validation of an Integrated Metabolism-Obesity Index for Screening Renal Impairment in Patients With Newly Diagnosed Type 2 Diabetes Mellitus.

BACKGROUND

Diabetic kidney disease, a severe diabetes microvascular complication affecting 30%~40% of diabetic patients, raises end-stage renal disease and mortality risks. This study is aimed at developing and validate a novel index combining obesity measures and metabolic parameters to screen renal impairment in newly diagnosed T2DM patients.

METHODS

A total of 387 and 259 newly diagnosed T2DM patients were recruited for model development and validation, respectively. Renal impairment was defined as eGFR < 60 mL/min/1.73 m2 and/or urinary albumin-to-creatinine ratio (UACR) ≥ 30 mg/g. Obesity- or metabolism-related indicators were collected. Significantly independent indicators were selected via bidirectional stepwise regression in the modeling patients to develop a comprehensive index termed InMOI. In the validation patients, restricted cubic spline analysis examined the dose-response relationship between InMOI and renal impairment, whereas ROC curves assessed the screening performance.

RESULTS

The triglyceride-glucose index (TyG) combined with various obesity measures showed significant associations with renal impairment. The InMOI, derived from TyG-BMI and TyG-waist to hip ratio (TyG-WHR), demonstrated a linear dose-response relationship with the odds ratio for renal impairment. InMOI achieved an AUC of 0.78 for identifying renal impairment. Optimizing the index by replacing WHR with the visceral-to-subcutaneous fat area ratio measured by DEXA, the modified InMOI (m-InMOI) showed a better performance (AUC = 0.81).

CONCLUSION

This study underscores the value of metabolism-obesity indices in early detection of diabetic renal damage and highlights the pathogenic role of visceral obesity and metabolic dysregulation in diabetic kidney disease. The InMOI provides a practical tool for large-scale screening and early prevention of diabetic kidney disease.