Novel subgroups of type 2 diabetes and their association with microvascular outcomes in an Asian Indian population: a data-driven cluster analysis: the INSPIRED study
Introduction Type 2 diabetes is characterized by considerable heterogeneity in its etiopathogenesis and clinical presentation. We aimed to identify clusters of type 2 diabetes in Asian Indians and to look at the clinical implications and outcomes of this clustering.Research design and methods From a...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2020-08-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/8/1/e001506.full |
| _version_ | 1827316897258930176 |
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| author | Ranjit Mohan Anjana Viswanathan Mohan Colin Palmer Ewan Pearson Rajendra Pradeepa Viswanathan Baskar Anand Thakarakkattil Narayanan Nair Saravanan Jebarani Moneeza Kalhan Siddiqui Ranjit Unnikrishnan |
| author_facet | Ranjit Mohan Anjana Viswanathan Mohan Colin Palmer Ewan Pearson Rajendra Pradeepa Viswanathan Baskar Anand Thakarakkattil Narayanan Nair Saravanan Jebarani Moneeza Kalhan Siddiqui Ranjit Unnikrishnan |
| author_sort | Ranjit Mohan Anjana |
| collection | DOAJ |
| description | Introduction Type 2 diabetes is characterized by considerable heterogeneity in its etiopathogenesis and clinical presentation. We aimed to identify clusters of type 2 diabetes in Asian Indians and to look at the clinical implications and outcomes of this clustering.Research design and methods From a network of 50 diabetes centers across nine states of India, we selected 19 084 individuals with type 2 diabetes (aged 10–97 years) with diabetes duration of less than 5 years at the time of first clinic visit and performed k-means clustering using the following variables: age at diagnosis, body mass index, waist circumference, glycated hemoglobin, serum triglycerides, serum high-density lipoprotein cholesterol and C peptide (fasting and stimulated). This was then validated in a national epidemiological data set of representative individuals from 15 states across India.Results We identified four clusters of patients, differing in phenotypic characteristics as well as disease outcomes: cluster 1 (Severe Insulin Deficient Diabetes, SIDD), cluster 2 (Insulin Resistant Obese Diabetes, IROD), cluster 3 (Combined Insulin Resistant and Deficient Diabetes, CIRDD) and cluster 4 (Mild Age-Related Diabetes, MARD). While SIDD and MARD are similar to clusters reported in other populations, IROD and CIRDD are novel clusters. Cox proportional hazards showed that SIDD had the highest hazards for developing retinopathy, followed by CIRDD, while CIRDD had the highest hazards for kidney disease.Conclusions Compared with previously reported clustering, we show two novel subgroups of type 2 diabetes in the Asian Indian population with important implications for prognosis and management. The coexistence of insulin deficiency and insulin resistance seems to be peculiar to the Asian Indian population and is associated with an increased risk of microvascular complications. |
| first_indexed | 2024-04-24T23:22:27Z |
| format | Article |
| id | doaj.art-1c8a2b0b92da4ab98723bf33f7cd80fb |
| institution | Directory Open Access Journal |
| issn | 2052-4897 |
| language | English |
| last_indexed | 2024-04-24T23:22:27Z |
| publishDate | 2020-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Diabetes Research & Care |
| spelling | doaj.art-1c8a2b0b92da4ab98723bf33f7cd80fb2024-03-16T05:15:08ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972020-08-018110.1136/bmjdrc-2020-001506Novel subgroups of type 2 diabetes and their association with microvascular outcomes in an Asian Indian population: a data-driven cluster analysis: the INSPIRED studyRanjit Mohan Anjana0Viswanathan Mohan1Colin Palmer2Ewan Pearson3Rajendra Pradeepa4Viswanathan Baskar5Anand Thakarakkattil Narayanan Nair6Saravanan Jebarani7Moneeza Kalhan Siddiqui8Ranjit Unnikrishnan9Madras Diabetes Research Foundation, Chennai, Tamil Nadu, IndiaDiabetology, Dr Mohan’s Diabetes Specialities Centre Gopalapuram, Chennai, Tamil Nadu, IndiaUniversity of DundeeDivision of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, Dundee, UKMadras Diabetes Research Foundation and, Dr. Mohan’s Diabetes Specialties Centre, Chennai, Tamil Nadu, IndiaData Management, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, IndiaDivision of Population Health and Genomics, University of Dundee School of Medicine, Dundee, Dundee, UKData Management, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, IndiaDivision of Population Health and Genomics, University of Dundee School of Medicine, Dundee, Dundee, UKDiabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, IndiaIntroduction Type 2 diabetes is characterized by considerable heterogeneity in its etiopathogenesis and clinical presentation. We aimed to identify clusters of type 2 diabetes in Asian Indians and to look at the clinical implications and outcomes of this clustering.Research design and methods From a network of 50 diabetes centers across nine states of India, we selected 19 084 individuals with type 2 diabetes (aged 10–97 years) with diabetes duration of less than 5 years at the time of first clinic visit and performed k-means clustering using the following variables: age at diagnosis, body mass index, waist circumference, glycated hemoglobin, serum triglycerides, serum high-density lipoprotein cholesterol and C peptide (fasting and stimulated). This was then validated in a national epidemiological data set of representative individuals from 15 states across India.Results We identified four clusters of patients, differing in phenotypic characteristics as well as disease outcomes: cluster 1 (Severe Insulin Deficient Diabetes, SIDD), cluster 2 (Insulin Resistant Obese Diabetes, IROD), cluster 3 (Combined Insulin Resistant and Deficient Diabetes, CIRDD) and cluster 4 (Mild Age-Related Diabetes, MARD). While SIDD and MARD are similar to clusters reported in other populations, IROD and CIRDD are novel clusters. Cox proportional hazards showed that SIDD had the highest hazards for developing retinopathy, followed by CIRDD, while CIRDD had the highest hazards for kidney disease.Conclusions Compared with previously reported clustering, we show two novel subgroups of type 2 diabetes in the Asian Indian population with important implications for prognosis and management. The coexistence of insulin deficiency and insulin resistance seems to be peculiar to the Asian Indian population and is associated with an increased risk of microvascular complications.https://drc.bmj.com/content/8/1/e001506.full |
| spellingShingle | Ranjit Mohan Anjana Viswanathan Mohan Colin Palmer Ewan Pearson Rajendra Pradeepa Viswanathan Baskar Anand Thakarakkattil Narayanan Nair Saravanan Jebarani Moneeza Kalhan Siddiqui Ranjit Unnikrishnan Novel subgroups of type 2 diabetes and their association with microvascular outcomes in an Asian Indian population: a data-driven cluster analysis: the INSPIRED study BMJ Open Diabetes Research & Care |
| title | Novel subgroups of type 2 diabetes and their association with microvascular outcomes in an Asian Indian population: a data-driven cluster analysis: the INSPIRED study |
| title_full | Novel subgroups of type 2 diabetes and their association with microvascular outcomes in an Asian Indian population: a data-driven cluster analysis: the INSPIRED study |
| title_fullStr | Novel subgroups of type 2 diabetes and their association with microvascular outcomes in an Asian Indian population: a data-driven cluster analysis: the INSPIRED study |
| title_full_unstemmed | Novel subgroups of type 2 diabetes and their association with microvascular outcomes in an Asian Indian population: a data-driven cluster analysis: the INSPIRED study |
| title_short | Novel subgroups of type 2 diabetes and their association with microvascular outcomes in an Asian Indian population: a data-driven cluster analysis: the INSPIRED study |
| title_sort | novel subgroups of type 2 diabetes and their association with microvascular outcomes in an asian indian population a data driven cluster analysis the inspired study |
| url | https://drc.bmj.com/content/8/1/e001506.full |
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