Clinical utility of novel diabetes subgroups in predicting vascular complications and mortality: up to 25 years of follow-up of the HUNT Study
Introduction Cluster analysis has previously revealed five reproducible subgroups of diabetes, differing in risks of diabetic complications. We aimed to examine the clusters’ predictive ability for vascular complications as compared with established risk factors in a general adult diabetes populatio...
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BMJ Publishing Group
2024-11-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/12/6/e004493.full |
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| author | Bjørn Olav Åsvold Elin Pettersen Sørgjerd Arnulf Langhammer Kare I Birkeland Paz Lopez-Doriga Ruiz Tore Julsrud Berg Eirin Beate Haug Vera Vik Bjarkø Sofia Carlsson Valeriya Lyssenko |
| author_facet | Bjørn Olav Åsvold Elin Pettersen Sørgjerd Arnulf Langhammer Kare I Birkeland Paz Lopez-Doriga Ruiz Tore Julsrud Berg Eirin Beate Haug Vera Vik Bjarkø Sofia Carlsson Valeriya Lyssenko |
| author_sort | Bjørn Olav Åsvold |
| collection | DOAJ |
| description | Introduction Cluster analysis has previously revealed five reproducible subgroups of diabetes, differing in risks of diabetic complications. We aimed to examine the clusters’ predictive ability for vascular complications as compared with established risk factors in a general adult diabetes population.Research design and methods Participants from the second (HUNT2, 1995–1997) and third (HUNT3, 2006–2008) surveys of the Norwegian population-based Trøndelag Health Study (HUNT Study) with adult-onset diabetes were included (n=1899). To identify diabetes subgroups, we used the same variables (age at diagnosis, body mass index, HbA1c, homeostasis model assessment estimates of beta cell function and insulin resistance, and glutamic acid decarboxylase antibodies) and the same data-driven clustering technique as in previous studies. We used Cox proportional hazards models to investigate associations between clusters and risks of vascular complications and mortality. We estimated the C-index and R2 to compare predictive abilities of the clusters to those of established risk factors as continuous variables. All models included adjustment for age, sex, diabetes duration and time of inclusion.Results We reproduced five subgroups with similar key characteristics as identified in previous studies. During median follow-up of 9–13 years (differing between outcomes), the clusters were associated with different risks of vascular complications and all-cause mortality. However, in prediction models, individual established risk factors were at least as good predictors as cluster assignment for all outcomes. For example, for retinopathy, the C-index for the model including clusters (0.65 (95% CI 0.63 to 0.68)) was similar to that of HbA1c (0.65 (95% CI 0.63 to 0.68)) or fasting C-peptide (0.66 (95% CI 0.63 to 0.68)) alone. For chronic kidney disease, the C-index for clusters (0.74 (95% CI 0.72 to 0.76)) was similar to that of triglyceride/high-density lipoprotein ratio (0.74 (95% CI 0.71 to 0.76)) or fasting C-peptide (0.74 (95% CI 0.72 to 0.76)), and baseline estimated glomerular filtration rate yielded a C-index of 0.76 (95% CI 0.74 to 0.78).Conclusions Cluster assignment did not provide better prediction of vascular complications or all-cause mortality compared with established risk factors. |
| format | Article |
| id | doaj-art-dbb2110dcaa44cb6a271db560555590f |
| institution | DOAJ |
| issn | 2052-4897 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-dbb2110dcaa44cb6a271db560555590f2025-08-20T02:48:42ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972024-11-0112610.1136/bmjdrc-2024-004493Clinical utility of novel diabetes subgroups in predicting vascular complications and mortality: up to 25 years of follow-up of the HUNT StudyBjørn Olav Åsvold0Elin Pettersen Sørgjerd1Arnulf Langhammer2Kare I Birkeland3Paz Lopez-Doriga Ruiz4Tore Julsrud Berg5Eirin Beate Haug6Vera Vik Bjarkø7Sofia Carlsson8Valeriya Lyssenko9Department of Endocrinology, Clinic of Medicine, St Olavs Hospital Trondheim University Hospital, Trondheim, NorwayHUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, NorwayHUNT Research Center, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, NorwayInstitute of Clinical Medicine, University of Oslo, Oslo, NorwayDepartment of Chronic Diseases, Norwegian Institute of Public Health, Oslo, NorwayDepartment of Endocrinology, Oslo University Hospital, Oslo, NorwayHUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, NorwayHUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, NorwayInstitute of Environmental Medicine, Karolinska Institute, Stockholm, SwedenDepartment of Clinical Science, Center for Diabetes Research, University of Bergen, Bergen, NorwayIntroduction Cluster analysis has previously revealed five reproducible subgroups of diabetes, differing in risks of diabetic complications. We aimed to examine the clusters’ predictive ability for vascular complications as compared with established risk factors in a general adult diabetes population.Research design and methods Participants from the second (HUNT2, 1995–1997) and third (HUNT3, 2006–2008) surveys of the Norwegian population-based Trøndelag Health Study (HUNT Study) with adult-onset diabetes were included (n=1899). To identify diabetes subgroups, we used the same variables (age at diagnosis, body mass index, HbA1c, homeostasis model assessment estimates of beta cell function and insulin resistance, and glutamic acid decarboxylase antibodies) and the same data-driven clustering technique as in previous studies. We used Cox proportional hazards models to investigate associations between clusters and risks of vascular complications and mortality. We estimated the C-index and R2 to compare predictive abilities of the clusters to those of established risk factors as continuous variables. All models included adjustment for age, sex, diabetes duration and time of inclusion.Results We reproduced five subgroups with similar key characteristics as identified in previous studies. During median follow-up of 9–13 years (differing between outcomes), the clusters were associated with different risks of vascular complications and all-cause mortality. However, in prediction models, individual established risk factors were at least as good predictors as cluster assignment for all outcomes. For example, for retinopathy, the C-index for the model including clusters (0.65 (95% CI 0.63 to 0.68)) was similar to that of HbA1c (0.65 (95% CI 0.63 to 0.68)) or fasting C-peptide (0.66 (95% CI 0.63 to 0.68)) alone. For chronic kidney disease, the C-index for clusters (0.74 (95% CI 0.72 to 0.76)) was similar to that of triglyceride/high-density lipoprotein ratio (0.74 (95% CI 0.71 to 0.76)) or fasting C-peptide (0.74 (95% CI 0.72 to 0.76)), and baseline estimated glomerular filtration rate yielded a C-index of 0.76 (95% CI 0.74 to 0.78).Conclusions Cluster assignment did not provide better prediction of vascular complications or all-cause mortality compared with established risk factors.https://drc.bmj.com/content/12/6/e004493.full |
| spellingShingle | Bjørn Olav Åsvold Elin Pettersen Sørgjerd Arnulf Langhammer Kare I Birkeland Paz Lopez-Doriga Ruiz Tore Julsrud Berg Eirin Beate Haug Vera Vik Bjarkø Sofia Carlsson Valeriya Lyssenko Clinical utility of novel diabetes subgroups in predicting vascular complications and mortality: up to 25 years of follow-up of the HUNT Study BMJ Open Diabetes Research & Care |
| title | Clinical utility of novel diabetes subgroups in predicting vascular complications and mortality: up to 25 years of follow-up of the HUNT Study |
| title_full | Clinical utility of novel diabetes subgroups in predicting vascular complications and mortality: up to 25 years of follow-up of the HUNT Study |
| title_fullStr | Clinical utility of novel diabetes subgroups in predicting vascular complications and mortality: up to 25 years of follow-up of the HUNT Study |
| title_full_unstemmed | Clinical utility of novel diabetes subgroups in predicting vascular complications and mortality: up to 25 years of follow-up of the HUNT Study |
| title_short | Clinical utility of novel diabetes subgroups in predicting vascular complications and mortality: up to 25 years of follow-up of the HUNT Study |
| title_sort | clinical utility of novel diabetes subgroups in predicting vascular complications and mortality up to 25 years of follow up of the hunt study |
| url | https://drc.bmj.com/content/12/6/e004493.full |
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