S-17-2: CLUSTER ANALYSIS OF DIABETES AND HYPERTENSION

Abstract

Diabetes mellitus is classified into type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) according to etiology. T1DM occurs due to autoimmune β-cell destruction, usually leading to absolute insulin deficiency, whereas T2DM occurs due to a heterogenous combination of a relative insulin deficiency and insulin resistance. A data-driven cluster analysis reported five exclusive subgroups for diabetes: cluster 1 (severe autoimmune diabetes [SAID]), cluster 2 (severe insulin-deficient diabetes [SIDD]), cluster 3 (severe insulin-resistant diabetes [SIRD]), cluster 4 (mild obesity-related diabetes [MOD]), and cluster 5 (mild age-related diabetes [MARD]) (Ahlqvist et al, 2018). The subgroups have an advantage over the other classification because it uses simple but pathophysiologically feasible factors and is proven to apply to ethnic and racial differences to estimate diabetic complications (Diabetes Res Clin Pract 2021:180;109067). The SIRD cluster shows obesity and moderate to severe insulin resistance with hyperinsulinemia. Under severe metabolic deterioration based on insulin resistance through ectopic fat accumulation, individuals with SIRD are at high risk of developing atherosclerotic cardiovascular disease (ASCVD). SIRD confers the highest risk of developing diabetic kidney disease (DKD), commonly in Caucasians [Ahlqvist et al., 2018)] and non-Caucasians [Tanabe, 2020]. I will discuss the possible connection between cluster-derived diabetes subgroups and hypertension-associated complications.