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Type 2 diabetes classification: a data-driven cluster study of the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort

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Type 2 diabetes classification: a data-driven cluster study of the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort. / Christensen, Diana Hedevang; Nicolaisen, Sia K; Ahlqvist, Emma et al.

In: BMJ open diabetes research & care, Vol. 10, No. 2, e002731, 04.2022.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

Harvard

Christensen, DH, Nicolaisen, SK, Ahlqvist, E, Stidsen, JV, Nielsen, JS, Hojlund, K, Olsen, MH, García-Calzón, S, Ling, C, Rungby, J, Brandslund, I, Vestergaard, P, Jessen, N, Hansen, T, Brøns, C, Beck-Nielsen, H, Sørensen, HT, Thomsen, RW & Vaag, A 2022, 'Type 2 diabetes classification: a data-driven cluster study of the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort', BMJ open diabetes research & care, vol. 10, no. 2, e002731. https://doi.org/10.1136/bmjdrc-2021-002731

APA

Christensen, D. H., Nicolaisen, S. K., Ahlqvist, E., Stidsen, J. V., Nielsen, J. S., Hojlund, K., Olsen, M. H., García-Calzón, S., Ling, C., Rungby, J., Brandslund, I., Vestergaard, P., Jessen, N., Hansen, T., Brøns, C., Beck-Nielsen, H., Sørensen, H. T., Thomsen, R. W., & Vaag, A. (2022). Type 2 diabetes classification: a data-driven cluster study of the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort. BMJ open diabetes research & care, 10(2), [e002731]. https://doi.org/10.1136/bmjdrc-2021-002731

CBE

Christensen DH, Nicolaisen SK, Ahlqvist E, Stidsen JV, Nielsen JS, Hojlund K, Olsen MH, García-Calzón S, Ling C, Rungby J, et al. 2022. Type 2 diabetes classification: a data-driven cluster study of the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort. BMJ open diabetes research & care. 10(2):Article e002731. https://doi.org/10.1136/bmjdrc-2021-002731

MLA

Vancouver

Christensen DH, Nicolaisen SK, Ahlqvist E, Stidsen JV, Nielsen JS, Hojlund K et al. Type 2 diabetes classification: a data-driven cluster study of the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort. BMJ open diabetes research & care. 2022 Apr;10(2):e002731. doi: 10.1136/bmjdrc-2021-002731

Author

Bibtex

@article{78faa14c222e44bebaa53d2daa1176e4,
title = "Type 2 diabetes classification:: a data-driven cluster study of the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort",
abstract = "INTRODUCTION: A Swedish data-driven cluster study identified four distinct type 2 diabetes (T2D) clusters, based on age at diagnosis, body mass index (BMI), hemoglobin A1c (HbA1c) level, and homeostatic model assessment 2 (HOMA2) estimates of insulin resistance and beta-cell function. A Danish study proposed three T2D phenotypes (insulinopenic, hyperinsulinemic, and classical) based on HOMA2 measures only. We examined these two new T2D classifications using the Danish Centre for Strategic Research in Type 2 Diabetes cohort.RESEARCH DESIGN AND METHODS: In 3529 individuals, we first performed a k-means cluster analysis with a forced k-value of four to replicate the Swedish clusters: severe insulin deficient (SIDD), severe insulin resistant (SIRD), mild age-related (MARD), and mild obesity-related (MOD) diabetes. Next, we did an analysis open to alternative k-values (ie, data determined the optimal number of clusters). Finally, we compared the data-driven clusters with the three Danish phenotypes.RESULTS: Compared with the Swedish findings, the replicated Danish SIDD cluster included patients with lower mean HbA1c (86 mmol/mol vs 101 mmol/mol), and the Danish MOD cluster patients were less obese (mean BMI 32 kg/m2 vs 36 kg/m2). Our data-driven alternative k-value analysis suggested the optimal number of T2D clusters in our data to be three, rather than four. When comparing the four replicated Swedish clusters with the three proposed Danish phenotypes, 81%, 79%, and 69% of the SIDD, MOD, and MARD patients, respectively, fitted the classical T2D phenotype, whereas 70% of SIRD patients fitted the hyperinsulinemic phenotype. Among the three alternative data-driven clusters, 60% of patients in the most insulin-resistant cluster constituted 76% of patients with a hyperinsulinemic phenotype.CONCLUSION: Different HOMA2-based approaches did not classify patients with T2D in a consistent manner. The T2D classes characterized by high insulin resistance/hyperinsulinemia appeared most distinct.",
keywords = "Denmark/epidemiology, Diabetes Mellitus, Type 2/diagnosis, Glycated Hemoglobin A/analysis, Humans, Insulin, Insulin Resistance, Insulin, Regular, Human, type 2 diabetes, cohort, classification, clusters, SYSTEM, SUBGROUPS, REGISTRY",
author = "Christensen, {Diana Hedevang} and Nicolaisen, {Sia K} and Emma Ahlqvist and Stidsen, {Jacob V} and Nielsen, {Jens Steen} and Kurt Hojlund and Olsen, {Michael H} and Sonia Garc{\'i}a-Calz{\'o}n and Charlotte Ling and J{\o}rgen Rungby and Ivan Brandslund and Peter Vestergaard and Niels Jessen and Torben Hansen and Charlotte Br{\o}ns and Henning Beck-Nielsen and S{\o}rensen, {Henrik T} and Thomsen, {Reimar W} and Allan Vaag",
note = "{\textcopyright} Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",
year = "2022",
month = apr,
doi = "10.1136/bmjdrc-2021-002731",
language = "English",
volume = "10",
journal = "BMJ open diabetes research & care",
issn = "2052-4897",
publisher = "BMJ Publishing Group",
number = "2",

}

RIS

TY - JOUR

T1 - Type 2 diabetes classification:

T2 - a data-driven cluster study of the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort

AU - Christensen, Diana Hedevang

AU - Nicolaisen, Sia K

AU - Ahlqvist, Emma

AU - Stidsen, Jacob V

AU - Nielsen, Jens Steen

AU - Hojlund, Kurt

AU - Olsen, Michael H

AU - García-Calzón, Sonia

AU - Ling, Charlotte

AU - Rungby, Jørgen

AU - Brandslund, Ivan

AU - Vestergaard, Peter

AU - Jessen, Niels

AU - Hansen, Torben

AU - Brøns, Charlotte

AU - Beck-Nielsen, Henning

AU - Sørensen, Henrik T

AU - Thomsen, Reimar W

AU - Vaag, Allan

N1 - © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2022/4

Y1 - 2022/4

N2 - INTRODUCTION: A Swedish data-driven cluster study identified four distinct type 2 diabetes (T2D) clusters, based on age at diagnosis, body mass index (BMI), hemoglobin A1c (HbA1c) level, and homeostatic model assessment 2 (HOMA2) estimates of insulin resistance and beta-cell function. A Danish study proposed three T2D phenotypes (insulinopenic, hyperinsulinemic, and classical) based on HOMA2 measures only. We examined these two new T2D classifications using the Danish Centre for Strategic Research in Type 2 Diabetes cohort.RESEARCH DESIGN AND METHODS: In 3529 individuals, we first performed a k-means cluster analysis with a forced k-value of four to replicate the Swedish clusters: severe insulin deficient (SIDD), severe insulin resistant (SIRD), mild age-related (MARD), and mild obesity-related (MOD) diabetes. Next, we did an analysis open to alternative k-values (ie, data determined the optimal number of clusters). Finally, we compared the data-driven clusters with the three Danish phenotypes.RESULTS: Compared with the Swedish findings, the replicated Danish SIDD cluster included patients with lower mean HbA1c (86 mmol/mol vs 101 mmol/mol), and the Danish MOD cluster patients were less obese (mean BMI 32 kg/m2 vs 36 kg/m2). Our data-driven alternative k-value analysis suggested the optimal number of T2D clusters in our data to be three, rather than four. When comparing the four replicated Swedish clusters with the three proposed Danish phenotypes, 81%, 79%, and 69% of the SIDD, MOD, and MARD patients, respectively, fitted the classical T2D phenotype, whereas 70% of SIRD patients fitted the hyperinsulinemic phenotype. Among the three alternative data-driven clusters, 60% of patients in the most insulin-resistant cluster constituted 76% of patients with a hyperinsulinemic phenotype.CONCLUSION: Different HOMA2-based approaches did not classify patients with T2D in a consistent manner. The T2D classes characterized by high insulin resistance/hyperinsulinemia appeared most distinct.

AB - INTRODUCTION: A Swedish data-driven cluster study identified four distinct type 2 diabetes (T2D) clusters, based on age at diagnosis, body mass index (BMI), hemoglobin A1c (HbA1c) level, and homeostatic model assessment 2 (HOMA2) estimates of insulin resistance and beta-cell function. A Danish study proposed three T2D phenotypes (insulinopenic, hyperinsulinemic, and classical) based on HOMA2 measures only. We examined these two new T2D classifications using the Danish Centre for Strategic Research in Type 2 Diabetes cohort.RESEARCH DESIGN AND METHODS: In 3529 individuals, we first performed a k-means cluster analysis with a forced k-value of four to replicate the Swedish clusters: severe insulin deficient (SIDD), severe insulin resistant (SIRD), mild age-related (MARD), and mild obesity-related (MOD) diabetes. Next, we did an analysis open to alternative k-values (ie, data determined the optimal number of clusters). Finally, we compared the data-driven clusters with the three Danish phenotypes.RESULTS: Compared with the Swedish findings, the replicated Danish SIDD cluster included patients with lower mean HbA1c (86 mmol/mol vs 101 mmol/mol), and the Danish MOD cluster patients were less obese (mean BMI 32 kg/m2 vs 36 kg/m2). Our data-driven alternative k-value analysis suggested the optimal number of T2D clusters in our data to be three, rather than four. When comparing the four replicated Swedish clusters with the three proposed Danish phenotypes, 81%, 79%, and 69% of the SIDD, MOD, and MARD patients, respectively, fitted the classical T2D phenotype, whereas 70% of SIRD patients fitted the hyperinsulinemic phenotype. Among the three alternative data-driven clusters, 60% of patients in the most insulin-resistant cluster constituted 76% of patients with a hyperinsulinemic phenotype.CONCLUSION: Different HOMA2-based approaches did not classify patients with T2D in a consistent manner. The T2D classes characterized by high insulin resistance/hyperinsulinemia appeared most distinct.

KW - Denmark/epidemiology

KW - Diabetes Mellitus, Type 2/diagnosis

KW - Glycated Hemoglobin A/analysis

KW - Humans

KW - Insulin

KW - Insulin Resistance

KW - Insulin, Regular, Human

KW - type 2 diabetes

KW - cohort

KW - classification

KW - clusters

KW - SYSTEM

KW - SUBGROUPS

KW - REGISTRY

U2 - 10.1136/bmjdrc-2021-002731

DO - 10.1136/bmjdrc-2021-002731

M3 - Journal article

C2 - 35428673

VL - 10

JO - BMJ open diabetes research & care

JF - BMJ open diabetes research & care

SN - 2052-4897

IS - 2

M1 - e002731

ER -