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MON-649 Application of the New Cluster-Based Classification of Adult Onset Diabetes in a South Texas Veteran Population

Recently a cluster-based classification of disease phenotypes has been developed as a tool to aid in improved characterization and management of diabetes. The majority of these studies have been completed in European populations, but it is unclear if these are applicable to other populations. Using...

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Autores principales: Trejo, Jonathan, Hernandez, Lyan Gondin, Esteve, Lucy M A, Vasquez, Libia, Pinkson, Sheila, Chen, Xi, Koops, Maureen, Tripathy, Devjit
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7207408/
http://dx.doi.org/10.1210/jendso/bvaa046.1629
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author Trejo, Jonathan
Hernandez, Lyan Gondin
Esteve, Lucy M A
Vasquez, Libia
Pinkson, Sheila
Chen, Xi
Koops, Maureen
Tripathy, Devjit
author_facet Trejo, Jonathan
Hernandez, Lyan Gondin
Esteve, Lucy M A
Vasquez, Libia
Pinkson, Sheila
Chen, Xi
Koops, Maureen
Tripathy, Devjit
author_sort Trejo, Jonathan
collection PubMed
description Recently a cluster-based classification of disease phenotypes has been developed as a tool to aid in improved characterization and management of diabetes. The majority of these studies have been completed in European populations, but it is unclear if these are applicable to other populations. Using these cohorts, we categorized patients in a South Texas VA diabetes clinic to evaluate if these phenotypes apply to that population. A retrospective cohort study was completed from August 2019 through October 2019, in which 120 patients’ records in the Audie Murphy VA Diabetes Clinic were reviewed for presence of macro and microvascular complications, type of anti-diabetic medication, lipid profile and HbA1c levels, and fasting C-peptide and GADab status. 86 patients who had anti-GADab and C-Peptide levels measured were then stratified into diabetic phenotype cohorts as defined by Ahlqvist et al. 2018, based on presence of diabetes associated autoantibodies, fasting C-peptide level, insulin use >200 U/day, BMI, and age >65. Six subjects belonged to the Severe Autoimmune Diabetes (SAID) cohort, with average GADab 713±301IU; 66% of the cohort had nephropathy, 33% had retinopathy. The Severe Insulin Deficiency (SIDD) cohort had 9 patients, with average fasting C-peptide of 0.58±0.08ng/ml, 44% of the cohort had retinopathy, nephropathy and CAD as complications. The Severe Insulin Resistant (SIRD) cohort had 26 patients; fasting C-peptide was 4.94±0.43ng/ml, 73% had nephropathy, 38% retinopathy and 46% CAD. The Mild Obesity Related (MOD) cohort had 35 patients with average BMI of 35±0.6 kg/m(2) and average A1c 7.9±0.2%. Nephropathy was the most prevalent complication, present in 49% of the cohort. The Mild Age Related (MARD) cohort had 10 patients, with average age of 71±1.0 years, with nephropathy and CAD present in 66% of the cohort. The highest gross prevalence of nephropathy was in the SIRD cohort, whereas highest prevalence of retinopathy was in the SIDD cohort, both of which are concordant with the recently reported study, although not statistically significant (p=0.28 and 0.65, respectively). There was no difference in prevalence of CAD between the different categories of diabetes. These findings in a South Texas VA diabetes clinic population reflect agreement in diabetes associated complications in clusters of diabetes based on insulin resistance and insulin deficiency. Targeted intensification of therapy based on the major underlying pathophysiologic abnormalities may delay or prevent micro and macrovascular complications. 1. Ahlqvist E, et al. Novel Subgroups of Adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. Lancet Endocrinology and Diabetes. 2018;6: 361-369.
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spelling pubmed-72074082020-05-13 MON-649 Application of the New Cluster-Based Classification of Adult Onset Diabetes in a South Texas Veteran Population Trejo, Jonathan Hernandez, Lyan Gondin Esteve, Lucy M A Vasquez, Libia Pinkson, Sheila Chen, Xi Koops, Maureen Tripathy, Devjit J Endocr Soc Diabetes Mellitus and Glucose Metabolism Recently a cluster-based classification of disease phenotypes has been developed as a tool to aid in improved characterization and management of diabetes. The majority of these studies have been completed in European populations, but it is unclear if these are applicable to other populations. Using these cohorts, we categorized patients in a South Texas VA diabetes clinic to evaluate if these phenotypes apply to that population. A retrospective cohort study was completed from August 2019 through October 2019, in which 120 patients’ records in the Audie Murphy VA Diabetes Clinic were reviewed for presence of macro and microvascular complications, type of anti-diabetic medication, lipid profile and HbA1c levels, and fasting C-peptide and GADab status. 86 patients who had anti-GADab and C-Peptide levels measured were then stratified into diabetic phenotype cohorts as defined by Ahlqvist et al. 2018, based on presence of diabetes associated autoantibodies, fasting C-peptide level, insulin use >200 U/day, BMI, and age >65. Six subjects belonged to the Severe Autoimmune Diabetes (SAID) cohort, with average GADab 713±301IU; 66% of the cohort had nephropathy, 33% had retinopathy. The Severe Insulin Deficiency (SIDD) cohort had 9 patients, with average fasting C-peptide of 0.58±0.08ng/ml, 44% of the cohort had retinopathy, nephropathy and CAD as complications. The Severe Insulin Resistant (SIRD) cohort had 26 patients; fasting C-peptide was 4.94±0.43ng/ml, 73% had nephropathy, 38% retinopathy and 46% CAD. The Mild Obesity Related (MOD) cohort had 35 patients with average BMI of 35±0.6 kg/m(2) and average A1c 7.9±0.2%. Nephropathy was the most prevalent complication, present in 49% of the cohort. The Mild Age Related (MARD) cohort had 10 patients, with average age of 71±1.0 years, with nephropathy and CAD present in 66% of the cohort. The highest gross prevalence of nephropathy was in the SIRD cohort, whereas highest prevalence of retinopathy was in the SIDD cohort, both of which are concordant with the recently reported study, although not statistically significant (p=0.28 and 0.65, respectively). There was no difference in prevalence of CAD between the different categories of diabetes. These findings in a South Texas VA diabetes clinic population reflect agreement in diabetes associated complications in clusters of diabetes based on insulin resistance and insulin deficiency. Targeted intensification of therapy based on the major underlying pathophysiologic abnormalities may delay or prevent micro and macrovascular complications. 1. Ahlqvist E, et al. Novel Subgroups of Adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. Lancet Endocrinology and Diabetes. 2018;6: 361-369. Oxford University Press 2020-05-08 /pmc/articles/PMC7207408/ http://dx.doi.org/10.1210/jendso/bvaa046.1629 Text en © Endocrine Society 2020. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Diabetes Mellitus and Glucose Metabolism
Trejo, Jonathan
Hernandez, Lyan Gondin
Esteve, Lucy M A
Vasquez, Libia
Pinkson, Sheila
Chen, Xi
Koops, Maureen
Tripathy, Devjit
MON-649 Application of the New Cluster-Based Classification of Adult Onset Diabetes in a South Texas Veteran Population
title MON-649 Application of the New Cluster-Based Classification of Adult Onset Diabetes in a South Texas Veteran Population
title_full MON-649 Application of the New Cluster-Based Classification of Adult Onset Diabetes in a South Texas Veteran Population
title_fullStr MON-649 Application of the New Cluster-Based Classification of Adult Onset Diabetes in a South Texas Veteran Population
title_full_unstemmed MON-649 Application of the New Cluster-Based Classification of Adult Onset Diabetes in a South Texas Veteran Population
title_short MON-649 Application of the New Cluster-Based Classification of Adult Onset Diabetes in a South Texas Veteran Population
title_sort mon-649 application of the new cluster-based classification of adult onset diabetes in a south texas veteran population
topic Diabetes Mellitus and Glucose Metabolism
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7207408/
http://dx.doi.org/10.1210/jendso/bvaa046.1629
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