Introduction and Objective: Prior studies identified 5 novel subgroups of type 2 diabetes (T2D) that may predict diabetes-related outcomes. However, these studies utilized laboratory measurements that are not part of a routine T2D visit limiting use in clinical care. Given the increasing prevalence of T2D in young adults (age <45 yrs), our goal was to determine subgroups of T2D associated with diabetes-related outcomes in young adults with routine clinical variables.Methods: Adults with the diagnosis of T2D (ICD codes 250.xx and E11.xx; n=352 826) with age at first diagnosis of T2D between 18-44 years (n=13 086) were identified from the Utah Diabetes Database. Those with missing data or laboratory data consistent with type 1 diabetes were excluded. Hierarchical analysis followed by k-means clustering was performed to determine 3 subgroups: cluster 1 (C1), cluster 2 (C2), and cluster 3 (C3), with results reported in this order.Results: Baseline clinical variables with the highest effect were age at first diagnosis, baseline BMI, HbA1c, and GFR. C1 had the highest BMI (45 ± 7 vs 30 ± 6 vs 30 ± 5 kg/m2, p<0.01) but lowest HbA1c (7.2 ± 2.1 vs 8.5 ± 2.8 vs 7.6 ± 2.4%, p<0.01). C2 was youngest (age 37 ± 5 vs 28 ± 5 vs 39 ± 4 yrs, p<0.01) with the highest HbA1c. C3 was older with the lowest GFR at baseline (104 ± 18 vs 115 ± 16 vs 86 ± 27 ml/min/1.73m2, p<0.01). On follow up, frequencies of complications significantly differed among clusters. C1 had moderate risks for nephropathy and hepatic fibrosis from metabolic dysfunction-associated liver disease (MASLD) but low risk for retinopathy and the least likely to require insulin. C2 had the highest risk for DKA and hypoglycemia, the lowest risk for nephropathy, and was more likely to require insulin. C3 had the highest risks for nephropathy, retinopathy, neuropathy and hepatic fibrosis from MASLD.Conclusion: Clinical subgroups of young adults with type 2 diabetes were associated with different outcomes. These subgroups may respond to precision pharmacotherapy based on the predicted outcomes.
A. Sharma: None. J.M. Lazaro-Guevara: None. M.G. Pezzolesi: None.
American Diabetes Association (7-22-JDFPM-04)
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