Highlights
- •Patients with type 2 diabetes can be categorized into four clusters with different diabetes-related outcomes.
- •Glycemic deterioration needed to initiate anti-diabetic therapy was earlier in severe insulin-deficient diabetes patients.
- •Patients with mild age-related diabetes and severe insulin-deficient diabetes showed the highest risk of complications.
Abstract
Background
Little is known about the subtypes of type 2 diabetes (T2D) and their association
with clinical outcomes in Asians.
Methods
We performed data-driven cluster analysis in patients with newly diagnosed drug-naive
T2D (n = 756) from the Korean Genome and Epidemiology Study. Clusters were based on
five variables (age at diagnosis, BMI, HbA1c, and HOMA2 β-cell function, and insulin
resistance).
Results
We identified four clusters of patients with T2D according to k-means clustering:
cluster 1 (22.4 %, severe insulin-resistant diabetes [SIRD]), cluster 2 (32.7 %, mild
age-related diabetes [MARD]), cluster 3 (32.7 %, mild obesity-related diabetes [MOD]),
and cluster 4 (12.3 %, severe insulin-deficient diabetes [SIDD]). During 14 years
of follow-up, individuals in the SIDD cluster had the highest risk of initiation of
glucose-lowering therapy compared to individuals in the other three clusters. Individuals
in the MARD and SIDD clusters showed the highest risk of chronic kidney disease and
cardiovascular disease, and individuals in the MOD clusters showed the lowest risk
after adjusting for other risk factors (P < 0.05).
Conclusions
Patients with T2D can be categorized into four subgroups with different glycemic deterioration
and risks of diabetes complications. Individualized management might be helpful for
better clinical outcomes in Asian patients with different T2D subgroups.
Graphical abstract
Graphical Abstract
Abbreviations:
BMI (body mass index), CKD (chronic kidney disease), CVD (cardiovascular disease), GFR (glomerular filtration rate), HOMA (homeostasis model assessment), MAFLD (metabolic dysfunction-associated fatty liver disease), MARD (mild age-related diabetes), MOD (mild obesity-related diabetes), OGTT (oral glucose tolerance test), SIDD (severe insulin-deficient diabetes), SIRD (severe insulin-resistant diabetes), T2D (type 2 diabetes)Keywords
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Article info
Publication history
Published online: February 04, 2023
Accepted:
February 1,
2023
Received:
November 16,
2022
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
