Glomerular Filtration Rate Trajectories in Patients with Type 2 Diabetes: Associated Factors in a Retrospective Cohort from Morocco

Background Diabetic nephropathy is a leading cause of end-stage renal disease (ESRD) globally. In patients with type 2 diabetes mellitus (T2DM), early identification of glomerular filtration rate (GFR) decline trajectories may inform personalised prevention strategies. This study aimed to identify typical patterns of GFR progression and the modifiable risk factors associated with rapid decline in a Moroccan T2DM population. Methods We conducted a retrospective cohort study including 2,698 patients with T2DM. Demographic, clinical, and laboratory data were collected from structured follow-up forms. GFR trajectories were modelled using the cluster-based longitudinal modelling of distributions (clusterMLD) method. Multivariable logistic regression adjusted for age, sex, and diabetes duration was used to identify predictors of rapid GFR decline, with non-linear associations explored via restricted cubic splines. Results Two distinct GFR trajectories were identified: Cluster 1 (high baseline GFR with slow decline) and Cluster 2 (low baseline GFR with rapid decline). Cluster 2 patients were older, predominantly female, and exhibited higher rates of obesity, poor glycaemic control, and dyslipidaemia. In multivariable analysis, high HbA1c (> 12%), elevated body mass index (> 35 kg/m²), hypertriglyceridaemia (≥ 1.2 g/L), and low HDL-cholesterol (< 0.6 g/L) were independently associated with rapid GFR decline. Conclusion This study highlights the heterogeneity of kidney function trajectories among Moroccan patients with T2DM. Targeting modifiable risk factors such as poor glycaemic control, obesity, and dyslipidaemia may reduce the risk of rapid renal deterioration. Our findings support the need for early risk stratification and personalised intervention strategies to improve long-term renal outcomes in T2DM.