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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

AIMS/INTRODUCTION: The aim of this study was 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 researc...

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Autores principales: Xiong, Xiao‐fen, Yang, Yuan, Wei, Ling, Xiao, Ying, Li, Li, Sun, Lin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354513/
https://www.ncbi.nlm.nih.gov/pubmed/33411406
http://dx.doi.org/10.1111/jdi.13494
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author Xiong, Xiao‐fen
Yang, Yuan
Wei, Ling
Xiao, Ying
Li, Li
Sun, Lin
author_facet Xiong, Xiao‐fen
Yang, Yuan
Wei, Ling
Xiao, Ying
Li, Li
Sun, Lin
author_sort Xiong, Xiao‐fen
collection PubMed
description AIMS/INTRODUCTION: The aim of this study was 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 carried out. First, we confirmed the European classification in Chinese populations by six parameters, including age at disease onset, body mass index, glycosylated hemoglobin, homeostatic model assessment 2 to estimate β‐cell function and insulin resistance, and glutamate decarboxylase antibodies. 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: Just three clusters were replicated in our cohort according to Emma Ahlqvist's 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 and inheritance‐related diabetes. Compared with patients with inheritance‐related diabetes, patients with severe insulin‐resistant diabetes showed a higher risk of diabetic peripheral neuropathy, hypertension and chronic kidney disease, and the uric acid‐related diabetes 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 inheritance‐related diabetes. Furthermore, 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 might contribute to the diagnosis and management of type 2 diabetes.
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spelling pubmed-83545132021-08-15 Identification of two novel subgroups in patients with diabetes mellitus and their association with clinical outcomes: A two‐step cluster analysis Xiong, Xiao‐fen Yang, Yuan Wei, Ling Xiao, Ying Li, Li Sun, Lin J Diabetes Investig Articles AIMS/INTRODUCTION: The aim of this study was 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 carried out. First, we confirmed the European classification in Chinese populations by six parameters, including age at disease onset, body mass index, glycosylated hemoglobin, homeostatic model assessment 2 to estimate β‐cell function and insulin resistance, and glutamate decarboxylase antibodies. 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: Just three clusters were replicated in our cohort according to Emma Ahlqvist's 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 and inheritance‐related diabetes. Compared with patients with inheritance‐related diabetes, patients with severe insulin‐resistant diabetes showed a higher risk of diabetic peripheral neuropathy, hypertension and chronic kidney disease, and the uric acid‐related diabetes 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 inheritance‐related diabetes. Furthermore, 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 might contribute to the diagnosis and management of type 2 diabetes. John Wiley and Sons Inc. 2021-02-14 2021-08 /pmc/articles/PMC8354513/ /pubmed/33411406 http://dx.doi.org/10.1111/jdi.13494 Text en © 2021 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Articles
Xiong, Xiao‐fen
Yang, Yuan
Wei, Ling
Xiao, Ying
Li, Li
Sun, Lin
Identification of two novel subgroups in patients with diabetes mellitus and their association with clinical outcomes: A two‐step cluster analysis
title Identification of two novel subgroups in patients with diabetes mellitus and their association with clinical outcomes: A two‐step cluster analysis
title_full Identification of two novel subgroups in patients with diabetes mellitus and their association with clinical outcomes: A two‐step cluster analysis
title_fullStr Identification of two novel subgroups in patients with diabetes mellitus and their association with clinical outcomes: A two‐step cluster analysis
title_full_unstemmed Identification of two novel subgroups in patients with diabetes mellitus and their association with clinical outcomes: A two‐step cluster analysis
title_short Identification of two novel subgroups in patients with diabetes mellitus and their association with clinical outcomes: A two‐step cluster analysis
title_sort identification of two novel subgroups in patients with diabetes mellitus and their association with clinical outcomes: a two‐step cluster analysis
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354513/
https://www.ncbi.nlm.nih.gov/pubmed/33411406
http://dx.doi.org/10.1111/jdi.13494
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