Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam University Medical Centre, Location VU University Medical Center, Amsterdam, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
PLoS One. 2020 Nov 30;15(11):e0242360. doi: 10.1371/journal.pone.0242360. eCollection 2020.
Subclasses of different glycaemic disturbances could explain the variation in characteristics of individuals with type 2 diabetes (T2D). We aimed to examine the association between subgroups based on their glucose curves during a five-point mixed-meal tolerance test (MMT) and metabolic traits at baseline and glycaemic deterioration in individuals with T2D.
The study included 787 individuals with newly diagnosed T2D from the Diabetes Research on Patient Stratification (IMI-DIRECT) Study. Latent class trajectory analysis (LCTA) was used to identify distinct glucose curve subgroups during a five-point MMT. Using general linear models, these subgroups were associated with metabolic traits at baseline and after 18 months of follow up, adjusted for potential confounders.
At baseline, we identified three glucose curve subgroups, labelled in order of increasing glucose peak levels as subgroup 1-3. Individuals in subgroup 2 and 3 were more likely to have higher levels of HbA1c, triglycerides and BMI at baseline, compared to those in subgroup 1. At 18 months (n = 651), the beta coefficients (95% CI) for change in HbA1c (mmol/mol) increased across subgroups with 0.37 (-0.18-1.92) for subgroup 2 and 1.88 (-0.08-3.85) for subgroup 3, relative to subgroup 1. The same trend was observed for change in levels of triglycerides and fasting glucose.
Different glycaemic profiles with different metabolic traits and different degrees of subsequent glycaemic deterioration can be identified using data from a frequently sampled mixed-meal tolerance test in individuals with T2D. Subgroups with the highest peaks had greater metabolic risk.
不同的血糖紊乱亚组可以解释 2 型糖尿病（T2D）患者特征的变化。我们旨在研究基于五点混合餐耐量试验（MMT）期间血糖曲线的亚组与 T2D 患者基线代谢特征和血糖恶化之间的关系。
该研究纳入了来自糖尿病患者个体化研究（IMI-DIRECT）的 787 名新诊断的 T2D 患者。采用潜在类别轨迹分析（LCTA）识别五点 MMT 期间不同的血糖曲线亚组。使用一般线性模型，在校正潜在混杂因素后，将这些亚组与基线和 18 个月随访时的代谢特征相关联。
基线时，我们确定了三个血糖曲线亚组，按血糖峰值水平递增的顺序分别标记为亚组 1-3。与亚组 1 相比，亚组 2 和 3 的患者基线时更有可能出现更高的 HbA1c、甘油三酯和 BMI 水平。在 18 个月（n=651）时，HbA1c（mmol/mol）变化的β系数（95%CI）随亚组增加，亚组 2 为 0.37（-0.18-1.92），亚组 3 为 1.88（-0.08-3.85），与亚组 1 相比。甘油三酯和空腹血糖的变化也呈现出相同的趋势。
在 T2D 患者中，使用频繁采样混合餐耐量试验的数据可以识别出具有不同代谢特征和不同程度后续血糖恶化的不同血糖谱。具有最高峰值的亚组具有更高的代谢风险。
