Lancet子刊：5种亚型分类，助糖尿病精准治疗 | 热心肠日报
成人型糖尿病的新亚型及其与预后的关联：对六个变量进行数据驱动的聚类分析
10.1016/S2213-8587(18)30051-2
2018-03-01, Article
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Background: Diabetes is presently classified into two main forms, type 1 and type 2 diabetes, but type 2 diabetes in particular is highly heterogeneous. A refined classification could provide a powerful tool to individualise treatment regimens and identify individuals with increased risk of complications at diagnosis.
Methods: We did data-driven cluster analysis (k-means and hierarchical clustering) in patients with newly diagnosed diabetes (n=8980) from the Swedish All New Diabetics in Scania cohort. Clusters were based on six variables (glutamate decarboxylase antibodies, age at diagnosis, BMI, HbA1c, and homoeostatic model assessment 2 estimates of β-cell function and insulin resistance), and were related to prospective data from patient records on development of complications and prescription of medication. Replication was done in three independent cohorts: the Scania Diabetes Registry (n=1466), All New Diabetics in Uppsala (n=844), and Diabetes Registry Vaasa (n=3485). Cox regression and logistic regression were used to compare time to medication, time to reaching the treatment goal, and risk of diabetic complications and genetic associations.
Findings: We identified five replicable clusters of patients with diabetes, which had significantly different patient characteristics and risk of diabetic complications. In particular, individuals in cluster 3 (most resistant to insulin) had significantly higher risk of diabetic kidney disease than individuals in clusters 4 and 5, but had been prescribed similar diabetes treatment. Cluster 2 (insulin deficient) had the highest risk of retinopathy. In support of the clustering, genetic associations in the clusters differed from those seen in traditional type 2 diabetes.
Interpretation: We stratified patients into five subgroups with differing disease progression and risk of diabetic complications. This new substratification might eventually help to tailor and target early treatment to patients who would benefit most, thereby representing a first step towards precision medicine in diabetes.
First Authors:
Emma Ahlqvist
Correspondence Authors:
Leif Groop
All Authors:
Emma Ahlqvist,Petter Storm,Annemari Käräjämäki,Mats Martinell,Mozhgan Dorkhan,Annelie Carlsson,Petter Vikman,Rashmi B Prasad,Dina Mansour Aly,Peter Almgren,Ylva Wessman,Nael Shaat,Peter Spégel,Hindrik Mulder,Eero Lindholm,Olle Melander,Ola Hansson,Ulf Malmqvist,Åke Lernmark,Kaj Lahti,Tom Forsén,Tiinamaija Tuomi,Anders H Rosengren,Leif Groop