Identification of two novel subgroups in patients with diabetes mellitus and their association with clinical outcomes: a two-step cluster analysis -…

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J Diabetes Investig. 2021 Jan 7. doi: 10.1111/jdi.13494. Online ahead of print.

ABSTRACT

AIMS/INTRODUCTION: It aims to determine whether distinct subphenotypes of patients with type 2 diabetes in the European classification exist in Chinese populations and to further establish novel subphenotypes more suitable for Chinese populations.

MATERIAL AND METHODS: The research retrospectively analyzed 5414 patients with type 2 diabetes from the National Clinical Research Center for Metabolic Diseases Diabetes Center in China, and a two-step cluster analysis was performed. First, we confirmed the European classification in Chinese populations by six parameters, including age at disease onset, body mass index (BMI), glycosylated hemoglobin (HbA1 c), homeostatic model assessment 2 to estimate -cell function (HOMA2-B) and insulin resistance (HOMA2-IR), and glutamate decarboxylase antibodies (GADA)). Furthermore, triglycerides and uric acid were added to refine the cluster analysis, and Cox regression was used to evaluate the risk of diabetic complications.

RESULTS: Only three clusters were replicated in our cohort according to Emma Ahlqvists European classification. When other variables were added to the cluster analysis, seven subgroups were identified, including five clusters of the European classification and two novel subgroups, namely, uric acid-related diabetes (UARD) and inheritance-related diabetes (IRD). Compared to cases with IRD, cases with severe insulin-resistant diabetes showed a higher risk of diabetic peripheral neuropathy, hypertension and chronic kidney disease, and the UARD subgroup showed a higher risk of coronary heart disease, cerebral vascular disease and end-stage renal disease. Patients with severe insulin-deficient diabetes showed a higher risk of diabetic retinopathy and diabetic foot than those with IRD. Moreover, there were sex-specific associations between subgroups and clinical outcomes. No significant difference was observed in the prevalence of cancer in each subgroup.

CONCLUSIONS: Seven subgroups of type 2 diabetes were identified in Chinese populations, with distinct characteristics and disparate clinical outcomes. This etiology-based stratification may contribute to the diagnosis and management of type 2 diabetes.

PMID:33411406 | DOI:10.1111/jdi.13494

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Identification of two novel subgroups in patients with diabetes mellitus and their association with clinical outcomes: a two-step cluster analysis -...