China is the largest country affected by the diabetes epidemic, with an estimated prevalence of about 12% and even greater pre-disease levels of 36%, but due to differences in ethnicities, regions, genetics, lifestyles and environmental factors, it isn’t clear whether the European classification of the condition applies to people of Chinese descent.
A team of researchers recently identified two novel subgroups in Chinese diabetes patients: uric acid and inheritance-related diabetes. The investigators were only able to pinpoint three Chinese subgroups that fall under the European classification umbrella of type 2 diabetes: severe insulin-deficient, severe autoimmune and mild age-related diabetes. When triglycerides and uric acid were added to the analysis, seven subgroups were found, including the five already mentioned, in addition to severe insulin-resistant diabetes and mild obesity-related diabetes.
Using data from the National Clinical Research Center for Metabolics Diseases Diabetes Center for China, the retrospective analysis included 5,414 patients with type 2 diabetes. The investigators cross-referenced the European classification of diabetes with the Chinese population using six parameters, including age at disease onset, BMI, HbA1c, glutamate decarboxylase antibodies, β-cell function and insulin resistance.
Compared with inheritance-related diabetes, severe insulin-resistant cases showed a higher risk of diabetic peripheral neuropathy, hypertension and chronic kidney disease, while the uric acid-related diabetes subgroup showed a higher risk of coronary heart disease, cerebral vascular disease and end-stage renal disease.
Patients with severe insulin-deficient diabetes showed a higher risk of diabetic retinopathy and diabetic foot-related issues compared with those with inheritance-related diabetes. Additionally, gender-specific associations were found between subgroups and clinical outcomes, but no major difference was observed in the prevalence of cancer in each group.
Xiong X-F, Yang Y, Wei L, et al. Identification of two novel subgroups in patients with diabetes mellitus and their association with clinical outcomes: a two-step cluster analysis. J Diabetes Investig. January 7, 2021. [Epub ahead of print].