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Article

Factors Associated with Risk of Diabetic Complications in Novel Cluster-Based Diabetes Subgroups: A Japanese Retrospective Cohort Study

1
Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University, Fukushima 960-1295, Japan
2
Department of Internal Medicine, Ohara General Hospital, Fukushima 960-8611, Japan
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Department of Internal Medicine, Shirakawa Kosei General Hospital, Fukushima 961-0005, Japan
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Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima 960-1295, Japan
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Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), University of the Ryukyu, Okinawa 903-0215, Japan
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Department of General Medicine, Tokyo-Kita Medical Center, Tokyo 115-0053, Japan
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Department of Nephrology and Hypertension, Iwate Medical University, Iwate 020-8505, Japan
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(7), 2083; https://doi.org/10.3390/jcm9072083
Received: 19 May 2020 / Revised: 28 June 2020 / Accepted: 29 June 2020 / Published: 2 July 2020
(This article belongs to the Special Issue Pathophysiology and Complications of Type 2 Diabetes Mellitus)
Diabetes is a complex and heterogeneous disease, making the prediction of the risks of diabetic complications challenging. Novel adult-onset diabetes subgroups have been studied using cluster analysis, but its application in East Asians remains unclear. We conducted a retrospective cohort study to elucidate the clinical utility of cluster-based subgroup analysis in the Japanese population. Cluster analysis based on anti-glutamate decarboxylase antibody (GAD antibody) levels, age at diagnosis, body mass index (BMI), hemoglobin A1c (A1c), and homeostatic model assessment 2 estimates of β-cell function and insulin resistance was performed in 1520 diabetic patients. The risk of developing diabetic complications was analyzed using Kaplan–Meier analysis and the Cox proportional hazards model. By cluster analysis, we identified five distinct subgroups of adult-onset diabetes in the Japanese population. The risk of diabetic complications varied greatly among the clusters. Patients with severe autoimmune diabetes or severe insulin deficiency diabetes were at an increased risk of diabetic retinopathy, and those with severe insulin resistant diabetes (SIRD) had the highest risk of developing diabetic kidney disease (DKD). After adjusting for uncorrectable and correctable risk factors, SIRD was found to be an independent risk factor for DKD. In conclusion, we identified five subgroups of adult-onset diabetes and the risk factors for diabetic complications in the Japanese population. This new classification system can be effective in predicting the risk of diabetic complications and for providing optimal treatment. View Full-Text
Keywords: type 2 diabetes; homeostasis model assessment (HOMA); chronic kidney disease; retinopathy; coronary artery disease type 2 diabetes; homeostasis model assessment (HOMA); chronic kidney disease; retinopathy; coronary artery disease
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MDPI and ACS Style

Tanabe, H.; Saito, H.; Kudo, A.; Machii, N.; Hirai, H.; Maimaituxun, G.; Tanaka, K.; Masuzaki, H.; Watanabe, T.; Asahi, K.; Kazama, J.; Shimabukuro, M. Factors Associated with Risk of Diabetic Complications in Novel Cluster-Based Diabetes Subgroups: A Japanese Retrospective Cohort Study. J. Clin. Med. 2020, 9, 2083. https://doi.org/10.3390/jcm9072083

AMA Style

Tanabe H, Saito H, Kudo A, Machii N, Hirai H, Maimaituxun G, Tanaka K, Masuzaki H, Watanabe T, Asahi K, Kazama J, Shimabukuro M. Factors Associated with Risk of Diabetic Complications in Novel Cluster-Based Diabetes Subgroups: A Japanese Retrospective Cohort Study. Journal of Clinical Medicine. 2020; 9(7):2083. https://doi.org/10.3390/jcm9072083

Chicago/Turabian Style

Tanabe, Hayato, Haruka Saito, Akihiro Kudo, Noritaka Machii, Hiroyuki Hirai, Gulinu Maimaituxun, Kenichi Tanaka, Hiroaki Masuzaki, Tsuyoshi Watanabe, Koichi Asahi, Junichiro Kazama, and Michio Shimabukuro. 2020. "Factors Associated with Risk of Diabetic Complications in Novel Cluster-Based Diabetes Subgroups: A Japanese Retrospective Cohort Study" Journal of Clinical Medicine 9, no. 7: 2083. https://doi.org/10.3390/jcm9072083

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