- •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.
Abbreviations: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)
American Diabetes Association: Standards of Medical Care in Diabetes - 2017. Diabetes care 2017;40:S1 – S135.
Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet 2016;388:1459–1544.
Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet 2015;386:743–800.
Benjamin EJ, Virani SS, Callaway CW, Chang AR, Cheng S, Chiuve SE, et al. Heart Disease and Stroke Statistics—2018 Update: A Report From the American Heart Association. Circulation; 2018.
Fox CS, Golden SH, Anderson C, Bray GA, Burke LE, de Boer IH, et al. Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association. Circulation 2015;132:691–718.
- Prevalence of and trends in diabetes among adults in the united states, 1988–2012.JAMA. 2015; 314: 1021-1029
- Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables.Lancet Diabet Endocrinol. 2018; 6: 361-369
- JT: Identification of type 2 diabetes subgroups through topological analysis of patient similarity.Sci Transl Med. 2015; 7: 311ra174
- Type 2 diabetes genetic loci informed by multi-trait associations point to disease mechanisms and subtypes: a soft clustering analysis.PLoS Med. 2018; 15: e1002654
Zipf G, Chiappa M, Porter KS, Ostchega Y, Lewis BG, Dostal J (Eds.). National health and nutrition examination survey: plan and operations, 1999-2010. 2013 publ. no. 0083-2014 (Print) 0083-2014).
Johnson CL, Paulose-Ram R, Ogden CL, Carroll MD, Kruszan-Moran D, Dohrmann SM, Curtin LR (Eds.). National health and nutrition examination survey. Analytic guidelines, 1999-2010; 2013.
NHANES Laboratory Data [article online], 2018. Available from <https://wwwn.cdc.gov/nchs/nhanes/search/datapage.aspx?Component=Laboratory> (Accessed March 11 2019).
- A new equation to estimate glomerular filtration rate.Ann Int Med. 2009; 150: 604-612
- Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline.Ann Int Med. 2013; 158: 825-830
National Center for Health Statistics: Lower Extremity Disease Procedures Manual. January 2004 ed., 2004 <https://wwwn.cdc.gov/nchs/data/nhanes/2003-2004/manuals/LE.pdf>.
- Prevalence of lower extremity diseases associated with normal glucose levels, impaired fasting glucose, and diabetes among U.S. adults aged 40 or older.Diabetes Res Clin Pract. 2007; 77: 485-488
- Prevalence of diabetic retinopathy in the united states, 2005–2008.JAMA. 2010; 304: 649-656
Early Treatment Diabetic Retinopathy Study Research Group: Grading diabetic retinopathy from stereoscopic color fundus photographs--an extension of the modified Airlie House classification. ETDRS report number 10. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991;98:786–806.
Jain D, Dubes R: Algorithms for Clustering Data Prentice Hall 1988. ISBN 0-13-022278-x, 1988.
- Note on grouping.J Am Stat Assoc. 1957; 52: 543-547
- On grouping for maximum homogeneity.J Am Stat Assoc. 1958; 53: 789-798
- Metric and Euclidean properties of dissimilarity coefficients.J Classif. 1986; 3: 5-48
- Multiple imputation of discrete and continuous data by fully conditional specification.Stat Methods Med Res. 2007; 16: 219-242
Yuan YC. Multiple Imputation for Missing Data: Concepts and New Development (Version 9.0). In: Proceedings of the Twenty-Fifth Annual SAS Users Group International Conference, Cary, NC: SAS Institute, 2000.
Goff DC, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R et al. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. Circulation 2014;129:S49.
- Low-density lipoprotein receptor activity in cultured human skin fibroblasts. Mechanism of insulin-induced stimulation.J Clin Investig. 1979; 64: 1309-1319
- Pathophysiology of diabetic dyslipidaemia: where are we?.Diabetologia. 2015; 58: 886-899
- Painting a new picture of personalised medicine for diabetes.Diabetologia. 2017; 60: 793-799
- Risk of diabetes-associated diseases in subgroups of patients with recent-onset diabetes: a 5-year follow-up study.The Lancet Diabetes & Endocrinology. 2019; 7 (In press): 684-694https://doi.org/10.1016/S2213-8587(19)30187-1
☆This work was completed while EWG was at the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.