Department of Endocrinology, Zhongda Hospital, Southeast University, Nanjing, China.
Institute of Glucose and Lipid Metabolism, Southeast University, Nanjing, China.
Front Endocrinol (Lausanne). 2022 Jul 27;13:927661. doi: 10.3389/fendo.2022.927661. eCollection 2022.
This study aimed to explore the novel classification of inpatients with new-onset diabetes in Eastern China by the cluster-based classification method and compare the clinical characteristics among the different subgroups.
A total of 1017 Inpatients with new-onset diabetes of five hospitals in Eastern China were included in the study. Clustering analysis was used to cluster the data into five subgroups according to six basic variables. The differences in clinical characteristics, treatments, and the prevalence of diabetes-related diseases among the five subgroups were analyzed by multiple groups comparisons and pairwise comparisons. The risk of diabetes-related diseases in the five subgroups was compared by calculating odd ratio (OR). value < 0.05 was considered significant.
Five subgroups were obtained by clustering analysis with the highest proportion of patients with severe insulin-deficient diabetes (SIDD) 451 (44.35%), followed by patients with mild age-related diabetes (MARD) 236 (23.21%), patients with mild obesity-related diabetes (MOD) 207 (20.35%), patients with severe insulin-resistant diabetes (SIRD) 81 (7.96%), and patients with severe autoimmune diabetes (SAID) 42 (4.13%). Five subtypes had their own unique characteristics and treatments. The prevalence and risk of diabetes-related complications and comorbidities were also significantly different among the five subtypes. Diabetic kidney disease (DKD) was the most common in SIRD group. Patients in SIDD, SIRD, and MARD groups were more likely to develop cardiovascular disease (CVD) and/or stroke, diabetic peripheral vascular disease (DPVD), and diabetic distal symmetric polyneuropathy (DSPN). The prevalence and risk of metabolic syndrome (MS) were the highest in MOD and SIRD groups. Patients in SAID group had the highest prevalence and risk of diabetic ketoacidosis (DKA). Patients with MOD were more likely to develop non-alcoholic fatty liver disease (NAFLD).
The inpatients with new-onset diabetes in Eastern China had the unique clustering distribution. The clinical characteristics, treatments, and diabetes-related complications and comorbidities of the five subgroups were different, which may provide the basis for precise treatments of diabetes.
本研究旨在通过聚类分类方法探讨中国东部新发糖尿病住院患者的新分类，并比较不同亚组之间的临床特征。
本研究共纳入中国东部五家医院的 1017 例新发糖尿病住院患者。根据六个基本变量，采用聚类分析将数据分为五个亚组。通过多组比较和两两比较分析五个亚组之间的临床特征、治疗方法和糖尿病相关疾病的患病率差异。通过计算比值比（OR）比较五个亚组中糖尿病相关疾病的风险。P 值＜0.05 为差异有统计学意义。
聚类分析得到五个亚组，其中严重胰岛素缺乏性糖尿病（SIDD）患者最多，为 451 例（44.35%），其次是轻度年龄相关性糖尿病（MARD）患者 236 例（23.21%）、轻度肥胖相关性糖尿病（MOD）患者 207 例（20.35%）、严重胰岛素抵抗性糖尿病（SIRD）患者 81 例（7.96%）和严重自身免疫性糖尿病（SAID）患者 42 例（4.13%）。五种亚型具有各自独特的特征和治疗方法。五种亚型的糖尿病相关并发症和合并症的患病率和风险也存在显著差异。SIRD 组中最常见的糖尿病相关并发症是糖尿病肾病（DKD）。SIDD、SIRD 和 MARD 组的患者更易发生心血管疾病（CVD）和/或中风、糖尿病周围血管病变（DPVD）和糖尿病远端对称性多发性神经病变（DSPN）。MOD 和 SIRD 组中代谢综合征（MS）的患病率和风险最高。SAID 组的糖尿病酮症酸中毒（DKA）患病率和风险最高。MOD 组的患者更易发生非酒精性脂肪性肝病（NAFLD）。
中国东部新发糖尿病住院患者具有独特的聚类分布。五个亚组的临床特征、治疗方法以及糖尿病相关并发症和合并症存在差异，这可能为糖尿病的精准治疗提供依据。
