Abstract

Type 2 diabetes is one of the subtypes of diabetes. However, previous studies have revealed its heterogeneous features. Here, we hypothesized that there would be heterogeneity in its development, resulting in higher susceptibility in some populations. We performed risk-factor based clustering (RFC), which is a hierarchical clustering of the population with profiles of five known risk factors for type 2 diabetes (age, gender, body mass index, hypertension, and family history of diabetes). The RFC identified six population clusters with significantly different prevalence rates of type 2 diabetes in the discovery data (N = 10,023), ranging from 0.09 to 0.44 (Chi-square test, P < 0.001). The machine learning method identified six clusters in the validation data (N = 215,083), which also showed the heterogeneity of prevalence between the clusters (P < 0.001). In addition to the prevalence of type 2 diabetes, the clusters showed different clinical features including biochemical profiles and prediction performance with the risk factors. SOur results seem to implicate a heterogeneous mechanism in the development of type 2 diabetes. These results will provide new insights for the development of more precise management strategy for type 2 diabetes.

Highlights

  • Diabetes is one of the most prevalent chronic diseases

  • These results indicates that the risk factors for type 2 diabetes have heterogeneous effects that are related to different clinical characteristics or genetic effects in the development of diabetes

  • The oral glucose tolerance test (OGTT) was applied in all follow-ups of the AA cohort, which allowed the accurate determination of type 2 diabetes

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Summary

Introduction

Diabetes is one of the most prevalent chronic diseases. The affected population is still growing, and it is estimated that 4−5 million people will develop diabetes until 20301,2. The heterogeneous effect of the risk factors is associated with genetic effect for development of type 2 diabetes. In genome-wide association studies, stratification by sex, body mass index (BMI), or ethnic group shows heterogeneous associations with genetic loci in type 2 diabetes[9,10,11,12,13,14,15,16]. The heterogeneous genetic effect was found between different ethnic groups[14,15] These results indicates that the risk factors for type 2 diabetes have heterogeneous effects that are related to different clinical characteristics or genetic effects in the development of diabetes. We hypothesized that stratification of type 2 diabetes based on multiple risk factors would show heterogeneity in the clinical features that cannot be identified from single-factor analysis.

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