Abstract
BackgroundSubgroups of type 2 diabetes (T2DM) have been well characterised in experimental studies. It is unclear, however, whether the same approaches can be used to characterise T2DM subgroups in UK primary care populations and their associations with clinical outcomes.AimTo derive T2DM subgroups using primary care data from a multi-ethnic population, evaluate associations with glycaemic control, treatment initiation, and vascular outcomes, and to understand how these vary by ethnicity.Design and settingAn observational cohort study in the East London Primary Care Database from 2008 to 2018.MethodLatent-class analysis using age, sex, glycated haemoglobin, and body mass index at diagnosis was used to derive T2DM subgroups in white, South Asian, and black groups. Time to treatment initiation and vascular outcomes were estimated using multivariable Cox-proportional hazards regression.ResultsIn total, 31 931 adults with T2DM were included: 47% South Asian (n = 14 884), 26% white (n = 8154), 20% black (n = 6423). Two previously described subgroups were replicated, ‘mild age-related diabetes’ (MARD) and ‘mild obesity-related diabetes’ (MOD), and a third was characterised ‘severe hyperglycaemic diabetes’ (SHD). Compared with MARD, SHD had the poorest long-term glycaemic control, fastest initiation of antidiabetic treatment (hazard ratio [HR] 2.02, 95% confidence interval [CI] = 1.76 to 2.32), and highest risk of microvascular complications (HR 1.38, 95% CI = 1.28 to 1.49). MOD had the highest risk of macrovascular complications (HR 1.50, 95% CI = 1.23 to 1.82). Subgroup differences in treatment initiation were most pronounced for the white group, and vascular complications for the black group.ConclusionClinically useful T2DM subgroups, identified at diagnosis, can be generated in routine real-world multi-ethnic populations, and may offer a pragmatic means to develop stratified primary care pathways and improve healthcare resource allocation.
Highlights
IntroductionType 2 diabetes (T2DM) is a heterogenous, multifactorial condition with major impact on the health of global populations and economic cost, largely mediated through its vascular complications.[1] Recent studies have identified distinct and replicable subgroups of T2DM in both experimental[2,3,4] and non-experimental (real-world) cohorts[5,6,7] and disease aetiology[8] using data-driven clustering methods
Type 2 diabetes (T2DM) is a heterogenous, multifactorial condition with major impact on the health of global populations and economic cost, largely mediated through its vascular complications.[1]. Recent studies have identified distinct and replicable subgroups of T2DM in both experimental[2,3,4] and non-experimental cohorts[5,6,7] and disease aetiology[8] using data-driven clustering methods. These studies have defined T2DM subgroups using clinical variables typically assessed in secondary care settings, including measures of insulin secretion and resistance, to delineate subgroups and their likely aetiology.[2,3,4,7] in the UK, the majority of type 2 diabetes management takes place in primary care settings, where these investigations are rarely performed
A total of 31,931 adults with type 2 diabetes were included in the study, of whom 47% were of south Asian ethnicity (n=14,884), 25% were of white ethnicity (n=8,154), 20% were of black ethnicity (n=6,423) and 6% were of mixed or other ethnicities (n=1,957)
Summary
Type 2 diabetes (T2DM) is a heterogenous, multifactorial condition with major impact on the health of global populations and economic cost, largely mediated through its vascular complications.[1] Recent studies have identified distinct and replicable subgroups of T2DM in both experimental[2,3,4] and non-experimental (real-world) cohorts[5,6,7] and disease aetiology[8] using data-driven clustering methods These studies have defined T2DM subgroups using clinical variables typically assessed in secondary care settings, including measures of insulin secretion and resistance (determined using C-peptide and glucose assays), to delineate subgroups and their likely aetiology.[2,3,4,7] in the UK, the majority of type 2 diabetes management takes place in primary care settings, where these investigations are rarely performed. It is unclear whether the same approaches can be used to characterise T2DM subgroups in UK primary care populations and associations with clinical outcomes
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
