Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Japan.
Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan.
J Diabetes Investig. 2022 Apr;13(4):706-713. doi: 10.1111/jdi.13707. Epub 2021 Dec 7.
AIMS/INTRODUCTION: We aimed to replicate a new diabetes subclassification based on objective clinical information at admission in a diabetes educational inpatient program. We also assessed the educational outcomes for each cluster.
We included diabetes patients who participated in the educational inpatient program during 2009-2020 and had sufficient clinical information for the cluster analysis. We applied a data-driven clustering method proposed in a previous study and further evaluated the clinical characteristics of each cluster. We investigated the association between the clusters and changes in hemoglobin A1c level from the start of the education program. We also assessed the risk of re-admission for the educational program.
We divided a total of 651 patients into five clusters. Their clinical characteristics followed the same pattern as in previous studies. The intercluster ranking of the cluster center coordinates showed strong correlation coefficients with those of the previous studies (mean ρ = 0.88). Patients classified as severe insulin-resistant diabetes (cluster 3) showed a more pronounced progression of renal dysfunction than patients classified as the other clusters. The patients classified as severe insulin-deficient diabetes (cluster 2) had the highest rate of reduction in hemoglobin A1c level from the start of the program (P < 0.01) and a tendency toward a lower risk of re-admission for the education program (hazard ratio 0.47, P = 0.09).
We successfully replicated the diabetes subclassification using objective clinical information at admission for the education program. In addition, we showed that severe insulin-deficient diabetes patients tended to have better educational outcomes than patients classified as the other clusters.
目的/引言：我们旨在通过在糖尿病教育住院计划中入院时的客观临床信息复制一种新的糖尿病亚分类，并评估每个聚类的教育结果。
我们纳入了 2009 年至 2020 年期间参加教育住院计划且聚类分析有足够临床信息的糖尿病患者。我们应用了先前研究中提出的数据驱动聚类方法，并进一步评估了每个聚类的临床特征。我们研究了聚类与教育计划开始时血红蛋白 A1c 水平变化之间的关系，并评估了再次参加教育计划的风险。
我们将总共 651 名患者分为五个聚类。他们的临床特征与先前研究的模式相同。聚类中心坐标的聚类间排名与先前研究的相关性很强（平均 ρ=0.88）。被归类为严重胰岛素抵抗性糖尿病的患者（聚类 3）的肾功能恶化程度比其他聚类更明显。被归类为严重胰岛素缺乏性糖尿病的患者（聚类 2）从项目开始时的血红蛋白 A1c 水平降低幅度最高（P<0.01），并且再次参加教育计划的风险较低（危险比 0.47，P=0.09）。
我们成功地使用入院时的客观临床信息复制了教育计划中的糖尿病亚分类。此外，我们表明严重胰岛素缺乏性糖尿病患者的教育效果倾向于优于其他聚类患者。
