Jacob V Stidsen1, Jan E Henriksen1, Michael H Olsen2, Reimar W Thomsen3, Jens S Nielsen1, Jørgen Rungby4,5, Sinna P Ulrichsen3, Klara Berencsi3, Johnny A Kahlert3, Søren G Friborg1, Ivan Brandslund6, Aneta A Nielsen6, Jens S Christiansen7, Henrik T Sørensen3, Thomas B Olesen1, Henning Beck-Nielsen1. 1. Diabetes Research Centre, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Odense, Denmark. 2. Department of Internal Medicine, Holbaek Hospital, and Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, University of Southern Denmark, Denmark. 3. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. 4. Department for Diabetes Research, Gentofte University Hospital, Gentofte, Denmark. 5. Department of Biomedicine, Aarhus University, Aarhus, Denmark. 6. Department of Biochemistry, Center Hospital Lillebaelt, Vejle, Denmark. 7. Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark.
Abstract
BACKGROUND: Type 2 diabetes may be a more heterogeneous disease than previously thought. Better understanding of pathophysiological subphenotypes could lead to more individualized diabetes treatment. We examined the characteristics of different phenotypes among 5813 Danish patients with new clinically diagnosed type 2 diabetes. METHODS: We first identified all patients with rare subtypes of diabetes, latent autoimmune diabetes of adults (LADA), secondary diabetes, or glucocorticoid-associated diabetes. We then used the homeostatic assessment model to subphenotype all remaining patients into insulinopenic (high insulin sensitivity and low beta cell function), classical (low insulin sensitivity and low beta cell function), or hyperinsulinemic (low insulin sensitivity and high beta cell function) type 2 diabetes. RESULTS: Among 5813 patients diagnosed with incident type 2 diabetes in the community clinical setting, 0.4% had rare subtypes of diabetes, 2.8% had LADA, 0.7% had secondary diabetes, 2.4% had glucocorticoid-associated diabetes, and 93.7% had WHO-defined type 2 diabetes. In the latter group, 9.7% had insulinopenic, 63.1% had classical, and 27.2% had hyperinsulinemic type 2 diabetes. Classical patients were obese (median waist 105 cm), and 20.5% had cardiovascular disease (CVD) at diagnosis, while insulinopenic patients were fairly lean (waist 92 cm) and 17.5% had CVD (P = 0.14 vs classical diabetes). Hyperinsulinemic patients were severely obese (waist 112 cm), and 25.5% had CVD (P < 0.0001 vs classical diabetes). CONCLUSIONS: Patients clinically diagnosed with type 2 diabetes are a heterogeneous group. In the future, targeted treatment based on pathophysiological characteristics rather than the current "one size fits all" approach may improve patient prognosis.
BACKGROUND:Type 2 diabetes may be a more heterogeneous disease than previously thought. Better understanding of pathophysiological subphenotypes could lead to more individualized diabetes treatment. We examined the characteristics of different phenotypes among 5813 Danish patients with new clinically diagnosed type 2 diabetes. METHODS: We first identified all patients with rare subtypes of diabetes, latent autoimmune diabetes of adults (LADA), secondary diabetes, or glucocorticoid-associated diabetes. We then used the homeostatic assessment model to subphenotype all remaining patients into insulinopenic (high insulin sensitivity and low beta cell function), classical (low insulin sensitivity and low beta cell function), or hyperinsulinemic (low insulin sensitivity and high beta cell function) type 2 diabetes. RESULTS: Among 5813 patients diagnosed with incident type 2 diabetes in the community clinical setting, 0.4% had rare subtypes of diabetes, 2.8% had LADA, 0.7% had secondary diabetes, 2.4% had glucocorticoid-associated diabetes, and 93.7% had WHO-defined type 2 diabetes. In the latter group, 9.7% had insulinopenic, 63.1% had classical, and 27.2% had hyperinsulinemic type 2 diabetes. Classical patients were obese (median waist 105 cm), and 20.5% had cardiovascular disease (CVD) at diagnosis, while insulinopenic patients were fairly lean (waist 92 cm) and 17.5% had CVD (P = 0.14 vs classical diabetes). Hyperinsulinemicpatients were severely obese (waist 112 cm), and 25.5% had CVD (P < 0.0001 vs classical diabetes). CONCLUSIONS:Patients clinically diagnosed with type 2 diabetes are a heterogeneous group. In the future, targeted treatment based on pathophysiological characteristics rather than the current "one size fits all" approach may improve patient prognosis.
Authors: Sooyeon Lee; Haixia Xu; Aidan Van Vleck; Alex M Mawla; Albert Mao Li; Jiangbin Ye; Mark O Huising; Justin P Annes Journal: Diabetes Date: 2022-07-01 Impact factor: 9.337
Authors: Abdallah Ahmed Gunaid; Mohammed Mohammed Al-Kebsi; Mahfouth Abdalla Bamashmus; Saleh Ahmed Al-Akily; Ahmed Nasser Al-Radaei Journal: BMJ Open Diabetes Res Care Date: 2018-12-07
Authors: Stefan Kabisch; Nina M T Meyer; Caroline Honsek; Christiana Gerbracht; Ulrike Dambeck; Margrit Kemper; Martin A Osterhoff; Andreas L Birkenfeld; Ayman M Arafat; Mads F Hjorth; Martin O Weickert; Andreas F H Pfeiffer Journal: Nutrients Date: 2019-10-06 Impact factor: 5.717
Authors: Diana Hedevang Christensen; Sia K Nicolaisen; Reimar W Thomsen; Allan Vaag; Emma Ahlqvist; Jacob V Stidsen; Jens Steen Nielsen; Kurt Hojlund; Michael H Olsen; Sonia García-Calzón; Charlotte Ling; Jørgen Rungby; Ivan Brandslund; Peter Vestergaard; Niels Jessen; Torben Hansen; Charlotte Brøns; Henning Beck-Nielsen; Henrik T Sørensen Journal: BMJ Open Diabetes Res Care Date: 2022-04
Authors: Stefan Kabisch; Nina Marie Tosca Meyer; Caroline Honsek; Christiana Gerbracht; Ulrike Dambeck; Margrit Kemper; Martin A Osterhoff; Andreas L Birkenfeld; Ayman M Arafat; Martin O Weickert; Andreas F H Pfeiffer Journal: Nutrients Date: 2019-11-11 Impact factor: 5.717