Jansson Sigfrids Fanny, Lithovius Raija, Groop Per-Henrik, Thorn Lena M
Folkhälsan Research Center, Helsinki, Finland.
Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland.
Diabet Med. 2025 Feb;42(2):e15431. doi: 10.1111/dme.15431. Epub 2024 Sep 5.
Across its operational span of more than 25 years, the observational, nationwide, multicentre Finnish Diabetic Nephropathy (FinnDiane) Study has aimed to unravel mechanisms underlying diabetic kidney disease, with a special focus on its metabolic risk factors. We sought to compile key findings relating to this topic and to offer a current perspective on the natural course of diabetic kidney disease among individuals with type 1 diabetes.
In this narrative review, articles relevant to the subject published by the FinnDiane Study were identified and summarized together with work published by others, when relevant.
The FinnDiane Study has underscored the significance of dysglycaemia and insulin resistance, increased visceral fat mass, hypertension and dyslipidaemia-particularly high triglycerides and remnant cholesterol-as risk factors for diabetic kidney disease. Factors like abdominal obesity seem to influence the early stages of the disease, while the presence of the metabolic syndrome becomes implicated at later stages. Epidemiological reports have revealed that after an initial decline, the cumulative incidence of albuminuria plateaued post-1980s, with the progression rate to kidney failure remaining high. Fortunately, 23% of the FinnDiane cohort regressed to less advanced stages of albuminuria, improving their overall prognosis.
A substantial burden of albuminuria associated with type 1 diabetes persists, and therefore, novel kidney-protecting therapies are highly awaited. In addition, given that metabolic factors influence the progression of diabetic kidney disease both in its early and advanced stages, emphasis should be placed on ensuring that their treatment targets are met.
在其超过25年的运营期间，芬兰糖尿病肾病（FinnDiane）这一全国性多中心观察性研究旨在揭示糖尿病肾病的潜在机制，特别关注其代谢危险因素。我们试图汇总与该主题相关的关键发现，并就1型糖尿病患者糖尿病肾病的自然病程提供当前观点。
在本叙述性综述中，识别并汇总了FinnDiane研究发表的与该主题相关的文章，以及其他相关研究发表的成果。
FinnDiane研究强调了血糖异常和胰岛素抵抗、内脏脂肪量增加、高血压和血脂异常（特别是高甘油三酯和残留胆固醇）作为糖尿病肾病危险因素的重要性。腹部肥胖等因素似乎影响疾病的早期阶段，而代谢综合征则在后期阶段起作用。流行病学报告显示，自20世纪80年代后，蛋白尿累积发病率在最初下降后趋于平稳，肾衰竭进展率仍然很高。幸运的是，FinnDiane队列中的23%病情回归到蛋白尿较轻阶段，改善了总体预后。
与1型糖尿病相关的蛋白尿负担仍然很大，因此，人们迫切期待新的肾脏保护疗法。此外，鉴于代谢因素在糖尿病肾病的早期和晚期均影响其进展，应强调确保达到其治疗目标。
