MARCH队列中新诊断2型糖尿病亚组及治疗反应的二次分析。

Secondary analysis of newly diagnosed type 2 diabetes subgroups and treatment responses in the MARCH cohort.

作者信息

Wang Weihao, Li Xinyao, Chen Fei, Wei Ran, Chen Zhi, Li Jingjing, Qiao Jingtao, Pan Qi, Yang Wenying, Guo Lixin

机构信息

Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.

School of Computer Science and Engineering, University of Electronic Science and Technology of China, China.

出版信息

Diabetes Metab Syndr. 2024 Jan;18(1):102936. doi: 10.1016/j.dsx.2023.102936. Epub 2023 Dec 30.

DOI:10.1016/j.dsx.2023.102936

PMID:38171152

Abstract

OBJECTIVE

To incorporate new clusters in the MARCH (Metformin and AcaRbose in Chinese patients as the initial Hypoglycemic treatment) cohort of newly diagnosed type 2 diabetes (T2D) patients and compare the anti-glycemic effects of metformin and acarbose across different clusters.

METHODS

K-means cluster analysis was performed based on six clinical indicators. The diabetic clusters in the MARCH cohort were retrospectively associated with the response to metformin and acarbose.

RESULTS

A total of 590 newly diagnosed T2D patients were classified by data-driven clusters into the MARD (mild obesity-related diabetes) (34.1 %), MOD (mild obesity-related diabetes) (34.1 %), SIDD (severe insulin-deficient diabetes) (20.3 %) and SIRD (severe insulin-resistant diabetes) (11.5 %) subgroups at baseline. At 24 and 48 weeks, 346 participants had finished the follow-up. After the adjustment of age, gender, weight, baseline HbA1c, baseline fasting glucose and 2-h postprandial blood glucose (2hPG), metformin mainly decreased the fasting glucose (0.07 ± 0.89 vs -0.26 ± 0.83, P = 0.043) in the MARD subgroup presented with OGTT (oral glucose tolerance test) results compared with acarbose group at 24 weeks. Acarbose led to a greater decrease in 2hPG in the MOD subgroup compared with metformin group (0.08 ± 0.86 vs -0.24 ± 0.92, P = 0.037) at 24 weeks. There was a also significant interaction between cluster and treatment efficacy in HbA1c (glycated hemoglobin) reduction in metformin and acarbose groups at 24 and 48 weeks (p<0.001).

CONCLUSIONS

Metformin and acarbose affected different metabolic variables depending on the diabetes subtype.

摘要

目的

将新诊断的2型糖尿病（T2D）患者纳入MARCH（二甲双胍和阿卡波糖作为中国患者初始降糖治疗）队列中的新聚类，并比较不同聚类中二甲双胍和阿卡波糖的降糖效果。

方法

基于六项临床指标进行K均值聚类分析。对MARCH队列中的糖尿病聚类与二甲双胍和阿卡波糖的反应进行回顾性关联分析。

结果

共有590例新诊断的T2D患者在基线时通过数据驱动聚类被分为MARD（轻度肥胖相关糖尿病）（34.1%）、MOD（轻度肥胖相关糖尿病）（34.1%）、SIDD（严重胰岛素缺乏糖尿病）（20.3%）和SIRD（严重胰岛素抵抗糖尿病）（11.5%）亚组。在24周和48周时，346名参与者完成了随访。在调整年龄、性别、体重、基线糖化血红蛋白（HbA1c）、基线空腹血糖和餐后2小时血糖（2hPG）后，在24周时，与阿卡波糖组相比，二甲双胍在呈现口服葡萄糖耐量试验（OGTT）结果的MARD亚组中主要降低了空腹血糖（0.07±0.89 vs -0.26±0.83，P = 0.043）。在24周时，与二甲双胍组相比，阿卡波糖在MOD亚组中导致2hPG下降幅度更大（0.08±0.86 vs -0.24±0.92，P = 0.037）。在24周和48周时，二甲双胍和阿卡波糖组在糖化血红蛋白（HbA1c）降低方面的聚类与治疗效果之间也存在显著交互作用（p<0.001）。