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Since type 2 diabetes (T2D) is a heterogenous disease, treatment of T2D appears to be better personalized depending on their underlining conditions. A recent attempt to classify adult-onset DM based on only 6 DM related variables (GAD antibodies, age at diagnosis, BMI, HbA1c, and HOMA2 indices) , showed that DM can be classified into 5 clusters, among them 4 represent T2D (Lancet Diabetes Endocrinol. 2018;6:361) . We here classified non-diabetic population to find risk cluster for incident DM, or to extend strategies for prevention of T2D. The participants were recruited from Iwaki study, a health promotion study of Japanese people. Among 1167 participants in 2014 (baseline) , 868 non-diabetic individuals who attended at least one time in 2015 to 20were included in this prospective study. A hierarchical cluster analysis was performed based on 5 variables (age, BMI, HbA1c, HOMA2-β, and HOMA2-IR) . The hazard ratios (HRs) for incident T2D of clusters observed were examined using Cox proportional hazards model. Traits (mean) of 5 clusters observed were as follows: age (clusters; 1: 60.1, 2: 58.7, 3: 63.6, 4: 36.1, 5: 48.3) , BMI (1: 20.8, 2: 24.2, 3: 22.9, 4: 20.7, 5: 27.7) , HbA1c (1: 5.54, 2: 5.67, 3: 6.01, 4: 5.41, 5: 5.73) , HOMA2-β (1: 82.8, 2: 101.8, 3: 78.5, 4: 101.4, 5: 143.1) , and HOMA2-IR (1: 0.53, 2: 0.79, 3: 0.73, 4: 0.57, 5: 1.16) . The HR for incident T2D was significantly higher in cluster 3 than in clusters 1, 2, and 4, even after adjustment for age and sex (HR (p) : 5.00 (0.005) , 4.90 (0.005) , and 10.4 (0.048) , respectively) . Accordingly, cluster 3 had significantly higher age and HbA1c than other clusters, lower HOMA2-β than clusters 2, 4, and 5, and lower HOMA2-IR and BMI than clusters 2 and 5. In summary, cluster analysis of a general non-diabetic population revealed a risk cluster for incident T2D, and, thus, individuals with characteristics representing the cluster (less insulin resistant but decreased insulin secretion, older age, and poor metabolic control) should be a target for prevention of incident T2D. Disclosure R.Ito: None. M.Daimon: None. S.Mizushiri: None. S.Ono: None. Y.Nishiya: None. A.Tamura: None. M.Murabayashi: None. A.Kamba: None. |
