Epidemiology of diabetes phenotypes and prevalent cardiovascular risk factors and diabetes complications in the National Health and Nutrition Examination Survey 2003–2014

Published:November 05, 2019DOI:https://doi.org/10.1016/j.diabres.2019.107915


      • We characterized unique diabetes subgroups among a representative US sample.
      • Subgroups were related to aging, obesity, hyperglycemia, and young adulthood-onset.
      • Subgroups differed in proportion by race/ethnicity, but not sex or over time.
      • Prevalence of cardiovascular risk factors and complications differed by subgroup.



      To characterize unique diabetes phenotypes among National Health and Nutrition Examination Survey (NHANES) participants and assess associations with race/ethnicity, cardiovascular disease (CVD) risk factors, and prevalent complications.


      We included participants (age ≥ 20 years) from NHANES exams 2003–04 through 2013–14 with diabetes (self-report of diabetes diagnosis or medication use, fasting glucose ≥7.0 mmol/L, random glucose ≥11.1 mmol/L, and glycated hemoglobin (HbA1c) ≥ 48 mmol/mol). We used k-means clustering to characterize unique diabetes subgroups based on data for age of diabetes diagnosis, body mass index (BMI), waist circumference, HbA1c, and years of insulin use. We estimated subgroup prevalence of CVD risk factors and microvascular complications, accounting for demographics and survey sampling.


      Among 4300 adults with diabetes, we identified four unique subgroups of diabetes related to aging (AR, 51.3%), severe obesity (SO, 30.3%), severe hyperglycemia (SH, 12.5%), and young adulthood-onset (YA, 5.9%). We observed differences in subgroup proportion by race/ethnicity. Compared to the AR phenotype, all groups had higher HbA1c and BMI, the YA and SO groups had greater blood pressure, and the YA group had greater prevalence of renal, eye, and neuropathy complications.


      Whether consideration of diabetes phenotypes with treatment strategies reduce diabetes incidence, morbidity, and mortality merits evaluation.


      ADA (American Diabetes Association), AR (aging related), BMI (body mass index), BP (blood pressure), CKD (chronic kidney disease), CVD (cardiovascular disease), HbA1c (glycated hemoglobin), HDL-C (high-density lipoprotein cholesterol), HOMA (homeostatic model assessment), IR (insulin resistance), YA (young adulthood-onset), LDL-C (low-density lipoprotein cholesterol), NHANES (National Health and Nutrition Examination Survey), SH (severe hyperglycemia), SO (severe obesity), WC (waist circumference)
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