Subtypes of Type 2 Diabetes and Prediabetes: Mortality and Excess Life Lost in South Asians

Le résumé fourni par la source

OBJECTIVE Current definitions of type 2 diabetes (T2D) and prediabetes do not capture their pathophysiological heterogeneity. We investigated data-driven subtypes of T2D and prediabetes and evaluated their associations with mortality. RESEARCH DESIGN AND METHODS We analyzed data from 14,036 South Asian participants from the CArdiometabolic Risk Reduction cohort using unsupervised k-means clustering based on five variables: age, BMI, HbA1c, insulin resistance, and beta-cell dysfunction. For each subtype of T2D or prediabetes, we estimated Cox hazard ratios (HRs) for all-cause and cardiovascular disease (CVD) mortality and excess years of life lost compared to normal glucose tolerance. RESULTS Among 2,639 participants with T2D, three subtypes emerged: Severe Insulin-Deficient Diabetes (SIDD;23.0%), Mild Insulin-Deficient Diabetes (MIDD;54.5%), and Severe Insulin-Resistant Diabetes (SIRD;22.5%). Among 4,992 participants with prediabetes, two subtypes were identified: Insulin-Deficient Prediabetes (IDPD;66.0%) and Insulin-Resistant Prediabetes (IRPD;34.0%). Over a median follow-up of 10.6 years, 1,076 deaths occurred (405 due to CVD). Compared with normal glucose tolerance, SIDD had the highest all-cause mortality HR (3.34 [95%CI, 2.39 to 4.68]), followed by MIDD (1.39[95%CI, 1.05 to 1.84]) and SIRD (1.67[95%CI, 1.15 to 2.41]). Among prediabetes subtypes, IDPD was associated with increased all-cause (HR: 1.32 [95%CI, 1.03 to 1.68]) and CVD mortality (HR:1.53 [95%CI, 1.00 to 2.34]), whereas IRPD was not. Excess years of life lost were greatest for SIDD (17.7 years), followed by MIDD (12.8 years) and SIRD (12.0 years). CONCLUSIONS Insulin-deficient subtypes made up a high proportion of T2D and prediabetes cases and were associated with higher mortality hazards and excess years of life lost.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.