Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables

Ahlqvist, Emma; Storm, Petter; Käräjämäki, Annemari; Martinell, Mats; Dorkhan, Mozhgan; Carlsson, Annelie; Vikman, Petter; Prasad, Rashmi B.; Aly, Dina Mansour; Almgren, Peter; Wessman, Ylva; Shaat, Nael; Sartipy, Peter; Mulder, Hindrik; Lindholm, Eero; Melander, Olle; Hansson, Ola; Malmqvist, Ulf; Lernmark, Åke; Lahti, Kaj; Forsén, Tom; Tuomi, Tiinamaija; Rosengren, Anders H.; Groop, Leif

doi:10.1016/s2213-8587(18)30051-2

Cited by 1,707 publications

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“…In addition, they chose variables for which the information was easily available, with the minimum number of laboratory tests. 3 In ANDIS, 1.5% of adults had type 1 diabetes, 5.3% had LADA and 1.2% had secondary diabetes arising from coexisting pancreatic disease. Missing data meant that the researchers could not classify 3.8% of patients.…”

Section: Five Clustersmentioning

confidence: 99%

“…3 After all, numerous biological pathways, arising from a variety of interactions between genes and environmental factors, cause the progressive loss of betacell mass, function or both that results in diabetes. Despite their different origins, the pathways end at a common destination: hyperglycaemia.…”

Section: A Heterogeneous Diseasementioning

confidence: 99%

“…For example, fewer than 10% of people with diabetes have latent autoimmune diabetes in adults (LADA), caused by auto-antibodies against glutamic acid decarboxylase, the enzyme responsible for synthesising gamma-aminobutyric acid (GABA). 3 Best known as an inhibitory neurotransmitter in the brain, islet beta-cells also produce GABA, which regulates their function. 5 At diagnosis, LADA is clinically indistinguishable from type 2 diabetes.…”

Section: A Heterogeneous Diseasementioning

confidence: 99%

“…Over time, however, LADA increasingly resembles type 1 diabetes. 3 Moreover, a growing number of studies suggest that early and intensive control of hyperglycaemia produces a persistent reduction in the risk of diabetic micro-and macrovascular complications, even if HbA1c levels are similar over the longer term or healthcare professionals subsequently intensify treatment. Several biological changes -including oxidative stress, non-enzymatic glycation of proteins, epigenetic changes and chronic inflammation -seem to lay the foundation for this "metabolic memory".…”

Section: A Heterogeneous Diseasementioning

confidence: 99%

“…2 More recently, genetic analysis helped delineate five subtypes of 'adult-onset diabetes' (see Table 1), which might represent "a first step towards precision medicine in diabetes". 3 "This paper has helped to start a vital conversation about how we categorise types of diabetes. With more than 3.6 million people diagnosed with diabetes in the UK, we hope to move away from the perhaps simplistic approach of using just two main types of diabetes, recognising the many different characPrecision diabetes treatment comes a step closer…”

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Precision diabetes treatment comes a step closer

Greener¹

2018

Prescriber

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Section: Five Clustersmentioning

confidence: 99%

Section: A Heterogeneous Diseasementioning

confidence: 99%

Section: A Heterogeneous Diseasementioning

confidence: 99%

Section: A Heterogeneous Diseasementioning

confidence: 99%

mentioning

confidence: 99%

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Precision diabetes treatment comes a step closer

Greener¹

2018

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Effects of a Low-Carbohydrate Dietary Intervention on Hemoglobin A_1c

Dorans

Bazzano

et al. 2022

JAMA Netw Open

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ImportanceLow-carbohydrate diets decrease hemoglobin A1c (HbA1c) among patients with type 2 diabetes at least as much as low-fat diets. However, evidence on the effects of low-carbohydrate diets on HbA1c among individuals with HbA1c in the range of prediabetes to diabetes not treated by diabetes medications is limited.ObjectiveTo study the effect of a behavioral intervention promoting a low-carbohydrate diet compared with usual diet on 6-month changes in HbA1c among individuals with elevated untreated HbA1c.Design, Setting, and ParticipantsThis 6-month randomized clinical trial with 2 parallel groups was conducted from September 2018 to June 2021 at an academic medical center in New Orleans, Louisiana. Laboratory analysts were blinded to assignment. Participants were aged 40 to 70 years with untreated HbA1c of 6.0% to 6.9% (42-52 mmol/mol). Data analysis was performed from November 2021 to September 2022.InterventionsParticipants were randomized to a low-carbohydrate diet intervention (target &lt;40 net grams of carbohydrates during the first 3 months; &lt;60 net grams for months 3 to 6) or usual diet. The low-carbohydrate diet group received dietary counseling.Main Outcomes and MeasuresSix-month change in HbA1c was the primary outcome. Outcomes were measured at 0, 3, and 6 months.ResultsOf 2722 prescreened participants, 962 underwent screening, and 150 were enrolled (mean [SD] age, 58.9 [7.9] years; 108 women [72%]; 88 Black participants [59%]) and randomized to either the low-carbohydrate diet intervention (75 participants) or usual diet (75 participants) group. Six-month data were collected on 142 participants (95%). Mean (SD) HbA1c was 6.16% (0.30%) at baseline. Compared with the usual diet group, the low-carbohydrate diet intervention group had significantly greater 6-month reductions in HbA1c (net difference, –0.23%; 95% CI, –0.32% to –0.14%; P &lt; .001), fasting plasma glucose (–10.3 mg/dL; 95% CI, –15.6 to –4.9 mg/dL; P &lt; .001), and body weight (–5.9 kg; 95% CI, –7.4 to –4.4 kg; P &lt; .001).Conclusions and RelevanceIn this randomized clinical trial, a low-carbohydrate dietary intervention led to improvements in glycemia in individuals with elevated HbA1c not taking glucose-lowering medication, but the study was unable to evaluate its effects independently of weight loss. This diet, if sustained, might be a useful dietary approach for preventing and treating type 2 diabetes, but more research is needed.Trial RegistrationClinicalTrials.gov Identifier: NCT03675360

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The Prevalence of Obesity Among Children With Type 2 Diabetes

et al. 2022

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ImportanceThe childhood obesity epidemic is presumed to drive pediatric type 2 diabetes (T2D); however, the global scale of obesity in children with T2D is unknown.ObjectivesTo evaluate the global prevalence of obesity in pediatric T2D, examine the association of sex and race with obesity risk, and assess the association of obesity with glycemic control and dyslipidemia.Data SourcesMEDLINE, Embase, CINAHL, Cochrane Library, and Web of Science were searched from database inception to June 16, 2022.Study SelectionObservational studies with at least 10 participants reporting the prevalence of obesity in patients with pediatric T2D were included.Data Extraction and SynthesisFollowing the Meta-analysis of Observational Studies in Epidemiology reporting guideline, 2 independent reviewers in teams performed data extraction and risk of bias and level of evidence analyses. The meta-analysis was conducted using a random-effects model.Main Outcomes and MeasuresThe primary outcomes included the pooled prevalence rates of obesity in children with T2D. The secondary outcomes assessed pooled prevalence rates by sex and race and associations between obesity and glycemic control and dyslipidemia.ResultsOf 57 articles included in the systematic review, 53 articles, with 8942 participants, were included in the meta-analysis. The overall prevalence of obesity among pediatric patients with T2D was 75.27% (95% CI, 70.47%-79.78%), and the prevalence of obesity at diabetes diagnosis among 4688 participants was 77.24% (95% CI, 70.55%-83.34%). While male participants had higher odds of obesity than female participants (odds ratio, 2.10; 95% CI, 1.33-3.31), Asian participants had the lowest prevalence of obesity (64.50%; 95% CI, 53.28%-74.99%), and White participants had the highest prevalence of obesity (89.86%; 95% CI, 71.50%-99.74%) compared with other racial groups. High heterogeneity across studies and varying degrees of glycemic control and dyslipidemia were noted.Conclusions and RelevanceThe findings of this systematic review and meta-analysis suggest that obesity is not a universal phenotype in children with T2D. Further studies are needed to consider the role of obesity and other mechanisms in diabetes genesis in this population.

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Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables

Cited by 1,707 publications

References 26 publications

Precision diabetes treatment comes a step closer

Precision diabetes treatment comes a step closer

Effects of a Low-Carbohydrate Dietary Intervention on Hemoglobin A_1c

The Prevalence of Obesity Among Children With Type 2 Diabetes

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Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables

Cited by 1,707 publications

References 26 publications

Precision diabetes treatment comes a step closer

Precision diabetes treatment comes a step closer

Effects of a Low-Carbohydrate Dietary Intervention on Hemoglobin A1c

The Prevalence of Obesity Among Children With Type 2 Diabetes

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Product

Resources

About

Effects of a Low-Carbohydrate Dietary Intervention on Hemoglobin A_1c