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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

23 Pages Posted: 31 Mar 2019

See all articles by Xiao-fen Xiong

Xiao-fen Xiong

Central South University - Department of Nephrology

Yuan Yang

Central South University - Department of Nephrology

Ling Wei

Central South University - Department of Nephrology

Ying Xiao

Central South University - Department of Nephrology

Li Li

Central South University - Department of Nephrology

Zhiguang Zhou

Central South University - Department of Endocrinology and Metabolism

Shiping Liu

Central South University - Department of Endocrinology and Metabolism

Xia Li

Central South University - Department of Endocrinology and Metabolism

Li Xiao

Central South University - Department of Nephrology

Niansong Wang

Shanghai Jiao Tong University (SJTU) - Affiliated Sixth People's Hospital

Fuyou Liu

Central South University - Department of Nephrology

Lin Sun

Central South University - Department of Nephrology

More...

Abstract

Background:   The present study aims to observe whether distinct subphenotypes of patients with type 2 diabetes mellitus (T2DM) in European classification exist in Chinese populations and further establish the novel subphenotypes by adjusted cluster analysis, which are more suitable for Chinese populations.  

Methods:   The research retrospectively analyzed 5414 patients with T2DM from National Clinical Research Center for Metabolic Diseases Diabetes Center, China, and the two-step cluster analysis was performed. Firstly, we confirmed the European classification in Chinese populations by six parameters. Further, triglyceride, high-density lipoprotein cholesterol, uric acid etc. were included to refine the cluster analysis, and the Cox regression was used to evaluate the risk of diabetic complications.

Findings:  Only three clusters were replicated in our cohort according to Emma Ahlqvists' European classification. When other variables were added into the cluster analysis, seven subgroups were identified including five clusters of European classification and two novel subgroups, which were uric acid related diabetes (UARD) and Untypical. Compared to Untypical, cases with severe insulin resistant diabetes showed higher risk of diabetic peripheral neuropathy, hypertension and chronic kidney disease, and UARD subgroup showed higher risk of coronary heart disease and end stage renal disease. Patients with severe insulin-deficient diabetes showed higher risk of diabetic foot than that of Untypical. No significant difference was observed in the prevalence of cancer in each subgroup.  

Interpretation:  Seven subgroups of T2DM were identified in Chinese populations with distinct characteristics and disparate clinical outcomes. This aetiology-based stratification may contribute to the diagnosis and management of T2DM.  

Funding Statement:  The National Basic Research Program of China (2016YFC1305501 and 2018YFC1314002).

Declaration of Interests: No potential conflicts of interest relevant to this article were reported.

Ethics Approval Statement:  This study was approved by the Hunan Research Ethics Committees in the Second Xiangya Hospital of Central South University, China.

Keywords: Diabetes; Type 2 diabetes; Cluster analysis; Classification of diabetes; Uric Acid; Insulin resistance.

Suggested Citation

Xiong, Xiao-fen and Yang, Yuan and Wei, Ling and Xiao, Ying and Li, Li and Zhou, Zhiguang and Liu, Shiping and Li, Xia and Xiao, Li and Wang, Niansong and Liu, Fuyou and Sun, Lin, Identification of Two Novel Subgroups in Patients with Diabetes Mellitus and Their Association with Clinical Outcomes: A Two-Step Cluster Analysis (March 27, 2019). Available at SSRN: https://ssrn.com/abstract=3362458

Xiao-fen Xiong

Central South University - Department of Nephrology

Hunan, 410011
China

Yuan Yang

Central South University - Department of Nephrology

Hunan, 410011
China

Ling Wei

Central South University - Department of Nephrology ( email )

Hunan, 410011
China

Ying Xiao

Central South University - Department of Nephrology ( email )

Hunan, 410011
China

Li Li

Central South University - Department of Nephrology

Hunan, 410011
China

Zhiguang Zhou

Central South University - Department of Endocrinology and Metabolism ( email )

Changsha, Hunan 410011
China

Shiping Liu

Central South University - Department of Endocrinology and Metabolism

Changsha, Hunan 410011
China

Xia Li

Central South University - Department of Endocrinology and Metabolism

Changsha, Hunan 410011
China

Li Xiao

Central South University - Department of Nephrology

Hunan, 410011
China

Niansong Wang

Shanghai Jiao Tong University (SJTU) - Affiliated Sixth People's Hospital

Shanghai
China

Fuyou Liu

Central South University - Department of Nephrology

Hunan, 410011
China

Lin Sun (Contact Author)

Central South University - Department of Nephrology ( email )

Hunan, 410011
China

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