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Associations Between Type 2 Diabetes Subtypes and Complications: Analysis of the Malaysia National Diabetes Registry
15 Pages Posted: 25 Mar 2022More...
Background: Type 2 diabetes (DM2) subtypes and associations with complications have not adequately been investigated in Asia-Pacific populations.
Methods: Analytical cohort (n=60946), extracted from 2019 Malaysia National Diabetes Registry, included 63·8% Malay, 16·7% Chinese, 11·3% Indian, and 11·3% other. A k-means cluster analysis was performed with complete data on six variables: age, DM2 duration, body mass index, metabolic syndrome severity, triglyceride-glucose index, and A 1c . Separate Cox regression models and time-to-event analysis (from DM2 diagnosis) assessed the hazard ratio and time-to-complications, adjusting for sex, age, and ethnicity.
Findings: Four clusters emerged: Mild Age-Related Diabetes (MARD) in n=21059 (35·6%), Severe Insulin-Deficient Diabetes (SIDD) in n=11751 (19·3%); Mild Obesity-Related Diabetes (MOD) in n=14700 (24·1%); and Severe Insulin-Resistant Diabetes (SIRD) in n=13436 (22·0%). Each cluster was compared to MARD. SIDD had later-onset and lowest hazard ratio (HR) for chronic kidney disease (CKD), HR=0·25 (0·24, 0·26); retinopathy HR=0·28 (0·27, 0·30); cerebrovascular disease HR=0·57 (0·47, 0·69), and ischemic heart disease HR= 0·83 (0·76, 0·91). MOD had lowest HR= 0·53 (0·34, 0·84) for limb amputations, and low HR for CKD, retinopathy, and cerebrovascular disease. SIRD had highest HR=1·43 (1·13, 1·81) for foot ulcers, low HR=0·59 (0·56, 0·63) for retinopathy and CKD, HR=0·77 (0·74, 0·80). Known severe CKD cases were excluded from National Diabetes Registry.
Interpretation: DM2 subtypes associate differently with complications in Malaysia, similar to patterns found in European cohorts. DM2 subtypes complications, particularly for advanced chronic kidney disease, deserve further longitudinal investigation.
Funding Information: This study was funded by the Malaysian Ministry of Health, RTI International, and Rush University (R3 pilot grant 0272101.001.001).
Declaration of Interests: The authors have declared no conflicts of interest.
Ethics Approval Statement: Ethical clearance for this retrospective review of de-identified data from the NDR was granted by the Malaysian Ministry of Health Medical Research and Ethics Committee (NMRR-21-172-58258 (IIR)).
Keywords: Diabetes subtypes, Diabetes classification, Diabetes complications, Registry, Epidemiological analysis
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