This is a longitudinal cohort study published in the Journal of Diabetes Research. A group of patients (median age 59 years), diagnosed with T2DN according to the American Diabetes Association (ADA) criteria, were included. Patients with type 1 diabetes or non-diabetic kidney diseases were excluded. The data for the study were collected over a 4.5-year follow-up period.

In addition to general parameters such as age, weight, height, etc., renal parameters like albuminuria and eGFR (for renal dysfunction) were considered. Laboratory parameters, fasting plasma glucose, HbA1c, lipid profile, serum creatinine, serum albumin, and thyroid-stimulating hormone (TSH) were also tested.
The threshold for progression of albuminuria and progression of renal dysfunction were defined accordingly. About 10% of patients worsened to higher levels of urinary albumin loss (micro- or macroalbuminuria). Those with existing albuminuria saw the highest risk of worsening. 32.5% of patients saw a decline in kidney function.

Several factors were linked to DKD progression. These included lifestyle, smoking, drinking, period of diabetes, etc. These results are consistent with previous studies showing worsening kidney function after albuminuria. While studies were not performed to establish the etiology of this progression, some reasons were highlighted. Visceral fat increases inflammation, oxidative stress, and endothelial dysfunction. Thyroid dysfunction may impair vascular health and promote kidney injury. Low serum albumin is both a consequence of kidney damage and a marker of systemic dysfunction.