Clinical phenotyping of newly diagnosed type 2 diabetes in Yemen

Abstract

ObjectiveTo identify clinical phenotypes of type 2 diabetes (T2D) among adults presenting with a first diagnosis of diabetes.Research design and methodsA total of 500 consecutive patients were subject to clinical assessment and laboratory investigations. We used data-driven cluster analysis to identify phenotypes of T2D based on clinical variables and Homeostasis Model Assessment (HOMA2) of insulin sensitivity and beta-cell function estimated from paired fasting blood glucose and specific insulin levels.ResultsThe cluster analysis identified three statistically different clusters: cluster 1 (high insulin resistance and high beta-cell function group), which included patients with low insulin sensitivity and high beta-cell function; cluster 2 (low insulin resistance and low beta-cell function group), which included patients with high insulin sensitivity but very low beta-cell function; and cluster 3 (high insulin resistance and low beta-cell function group), which included patients with low insulin sensitivity and low beta-cell function. Insulin sensitivity, defined as median HOMA2-S, was progressively increasing from cluster 1 (35.4) to cluster 3 (40.9), to cluster 2 (76) (p<0.001). On the contrary, beta-cell function, defined as median HOMA2-β, was progressively declining from cluster 1 (78.3) to cluster 3 (30), to cluster 2 (22.3) (p<0.001). Clinical and biomarker variables associated with insulin resistance like obesity, abdominal adiposity, fatty liver, and high serum triglycerides were mainly seen in clusters 1 and 3. The highest median hemoglobin A1c value was noted in cluster 2 (88 mmol/mol) and the lowest in cluster 1.ConclusionCluster analysis of newly diagnosed T2D in adults has identified three phenotypes based on clinical variables central to the development of diabetes and on specific clinical variables of each phenotype.

Current Pharmacological Treatment of Type 2 Diabetes Mellitus in Undocumented Migrants: Is It Appropriate for the Phenotype of the Disease?

“…Our data are far from conclusive, but we can say that studying the features of T2D in a population made of western residents and undocumented migrants, we obtained distinct clusters of disease phenotypes. This is not different from what was observed by other researchers in more homogeneous populations [3,4]. This clustering appeared to be at least partially independent from racial/ethnical factors.…”

“…Type 2 diabetes (T2D), on the contrary, appears to represent a wide spectrum of metabolic disorders sharing chronic hyperglycaemia as a common feature. It is now clear that a classification more respondent to precision medicine criteria is needed, and attempts have been made to group T2D patients into different homogenous clusters [3,4]. This need for a better understanding of T2D phenotypes has practical implications for the pharmacological treatment of this disease.…”

Cardiorenal Risk Profiles Among Data-Driven Type 2 Diabetes Sub-Phenotypes: A Post-Hoc Analysis of the China Health and Nutrition Survey

“…This suggests current classifying method has, at least partly, captured their heterogeneities among diabetic patients. Also, compared to BMI, waist circumference shows a similar distribution and equivalent effect sizes among T2D sub-phenotypes, indicating that including both BMI and waist circumference as cluster variables in the study might be information redundancy ( 23 , 24 ). However, the HDL level was much less distinct among different diabetes sub-phenotypes.…”

Prediction of antidiabetic effect after gastrectomy with Roux-en-Y reconstruction in patients with gastric cancer and type 2 diabetes

“…However, even in patients with a short duration of T2DM, a severe decrease in beta cell function can often be observed. [26,27] Considering these individual differences, there is a limit to predicting the long-term outcome of glycemic control only by the duration of diabetes. Nannipieri et al reported that T2DM remission after RYGB depends on the initial degree of beta cell dysfunction in morbidly obese individuals, [28] and it is not fully clear whether similar results could be expected in patients with gastric cancer with a relatively lean state.…”

“…However, even in patients with a short duration of T2DM, a severe decrease in beta cell function can often be observed. [26,27] Considering these individual differences, there is a limit to predicting the long-term outcome of glycemic control only by the duration of diabetes.…”