Lu Brian, Li Peng, Crouse Andrew B, Grimes Tiffany, Might Matthew, Ovalle Fernando, Shalev Anath
Comprehensive Diabetes Center, Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
J Clin Endocrinol Metab. 2025 Jan 21;110(2):387-395. doi: 10.1210/clinem/dgae516.
Diabetes is a heterogenic disease and distinct clusters have emerged, but the implications for diverse populations have remained understudied.
Apply cluster analysis to a diverse diabetes cohort in the US Deep South.
Retrospective hierarchical cluster analysis of electronic health records from 89 875 patients diagnosed with diabetes between January 1, 2010, and December 31, 2019, at the Kirklin Clinic of the University of Alabama at Birmingham, an ambulatory referral center.
Adult patients with International Classification of Diseases diabetes codes were selected based on available data for 6 established clustering parameters (glutamic acid decarboxylase autoantibody; hemoglobin A1c; body mass index; diagnosis age; HOMA2-B; HOMA2-IR); ∼42% were Black/African American.
MAIN OUTCOME MEASURE(S): Diabetes subtypes and their associated characteristics in a diverse adult population based on clustering analysis. We hypothesized that racial background would affect the distribution of subtypes. Outcome and hypothesis were formulated prior to data collection.
Diabetes cluster distribution was significantly different in Black/African Americans compared to Whites (P < .001). Black/African Americans were more likely to have severe insulin-deficient diabetes (OR, 1.83; 95% CI, 1.36-2.45; P < .001), associated with more serious metabolic perturbations and a higher risk for complications (OR, 1.42; 95% CI, 1.06-1.90; P = .020). Surprisingly, Black/African Americans specifically had more severe impairment of β-cell function (homoeostatic model assessment 2 estimates of β-cell function, C-peptide) (P < .001) but not being more obese or insulin resistant.
Racial background greatly influences diabetes cluster distribution and Black/African Americans are more frequently and more severely affected by severe insulin-deficient diabetes. This may further help explain the disparity in outcomes and have implications for treatment choice.
糖尿病是一种异质性疾病，已出现不同的聚类，但对不同人群的影响仍研究不足。
对美国深南部不同的糖尿病队列应用聚类分析。
对2010年1月1日至2019年12月31日期间在阿拉巴马大学伯明翰分校柯克林诊所（一家门诊转诊中心）被诊断为糖尿病的89875例患者的电子健康记录进行回顾性分层聚类分析。
根据6个既定聚类参数（谷氨酸脱羧酶自身抗体；糖化血红蛋白；体重指数；诊断年龄；HOMA2 - B；HOMA2 - IR）的可用数据，选择患有国际疾病分类糖尿病编码的成年患者；约42%为黑人/非裔美国人。
基于聚类分析的不同成年人群中的糖尿病亚型及其相关特征。我们假设种族背景会影响亚型分布。结果和假设在数据收集之前制定。
与白人相比，黑人/非裔美国人的糖尿病聚类分布显著不同（P < 0.001）。黑人/非裔美国人更有可能患有严重胰岛素缺乏性糖尿病（比值比，1.83；95%置信区间，1.36 - 2.45；P < 0.001），与更严重的代谢紊乱和更高的并发症风险相关（比值比，1.42；95%置信区间，1.06 - 1.90；P = 0.020）。令人惊讶的是，黑人/非裔美国人特别有更严重的β细胞功能损害（β细胞功能的稳态模型评估2估计值、C肽）（P < 0.001），但并非更肥胖或胰岛素抵抗。
种族背景极大地影响糖尿病聚类分布，黑人/非裔美国人更频繁且更严重地受到严重胰岛素缺乏性糖尿病的影响。这可能进一步有助于解释结局的差异，并对治疗选择有影响。
