| Objective In this study,type 2 diabetes mellitus(T2DM)patients newly diagnosed(course≤1 year)and T2 DM patients non-newly diagnosed(course>1 year)were taken as subjects,and analysis of cluster classification was carried out using indicators that were easily available in clinical practice,aiming to verify the applicability and stability of the new diabetic classification proposed by the Swedish team in newly diagnosed T2 DM patients and non-newly diagnosed T2 DM patients,comparing whether there were differences in the blood lipids,the prevalence of dyslipidemia and its components among these subtypes,analyzing the medication of each subtype,and providing new ideas for better prevention,control and management of diabetes mellitus.Methods From January 2019 to December 2021,1005 patients with T2 DM who were hospitalized in the Department of Endocrinology and Metabolism of the Second Hospital of Lanzhou University were divided into newly diagnosed T2 DM patients(n=567)and non-newly diagnosed T2 DM patients(n=438).Collecting basic information and clinical data of all T2 DM patients,including age,sex,course,body mass index(BMI),glycosylated hemoglobin(Hb A1c),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FBG),fasting insulin(FINS),fasting C-peptide(FCP),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),smoking history,drinking history,hypertension,diabetes-related complications,and medication after discharge.The insulin resistance index estimated by HOMA2(HOMA2-IR)and the β cell function index estimated by HOMA2(HOMA2-β)were calculated using the FBG and FCP with the HOMA2 calculator.Based on age,BMI,Hb A1 c,HOMA2-IR,and HOMA2-β,those indicators were used as clustering variables,and K-means clustering was performed to classify the subjects into new subtypes to verify the applicability and stability of the new diabetic classification proposed by the Swedish team in newly diagnosed T2 DM patients and non-newly diagnosed T2 DM patients.And then we compared the blood lipids,the prevalence of dyslipidemia and its components,as well as the use of clinical drugs of each subtype.SPSS25.0 was used for statistical analysis of the above data,Graph Pad Prism 8.0 was used for mapping,and Microsoft Office Excel 2010 was used for mapping and tabulation.Results 1.Newly diagnosed T2 DM patients:(1)Basic information: 567 newly diagnosed patients with T2 DM were included in this study,with an average age of52.47 ± 11.60 years old.There were 380 males(67.02%)and 187 females(32.98%).The level of TC,HDL-C and LDL-C in females was higher than that in males(P<0.05).There was no significant difference in the level of TG between the two groups(P>0.05).The overall prevalence of dyslipidemia in newly diagnosed T2 DM patients was 76.54% and the prevalence of high TC,high TG,low HDL-C and high LDL-C was 24.87%,55.73%,37.04%,and 29.45%,respectively.Among them,the prevalence of females with high TC and high LDL-C(34.76% and 39.57%)was higher than that in males(20.00% and 24.47%)(P<0.05)and the prevalence of males with low HDL-C(44.74%)was higher than that in females(21.39%)(P<0.05).There was no significant difference in the prevalence of high TG between males(57.89%)and females(51.34%)(P>0.05).(2)Cluster characteristics: 567 newly diagnosed T2 DM patients were divided into the following four subtypes: severe insulin deficiency diabetes(SIDD),mild age-related diabetes(MARD),severe insulin resistance diabetes(SIRD)and mild obesity-related diabetes(MOD),with each subtype accounting for 23.99%,29.81%,19.58%,and 26.63% respectively.For SIDD,low age,low BMI,the poorest blood glucose control,low insulin resistance(IR),the poorest β-cell function,and the most serious insulin deficiency.The number of MARD accounts for the largest proportion with older age,low BMI,better blood glucose control,light IR,better β-cell function.For SIRD,low age,high BMI,poor blood glucose control,the most serious IR and poor β-cell function.For MOD,old age,high BMI,good glocose control,high IR and good β-cell function.(3)Comparison of blood lipids and other indicators of each subtype after cluster classification: The level of TC and LDL-C in SIDD and SIRD was higher than that in MARD and MOD(P<0.05);the level of TG in SIRD was higher than that in SIDD,MARD,MOD and the level of TG in SIDD was higher than that in MARD(P<0.05);the level of HDL-C in SIDD and MARD was higher than that in SIRD,and the level of HDL-C in MARD was higher than that in MOD(P<0.05).Age,BMI,Hb A1 c,HOMA2-IR,HOMA2-β,DBP,FBG,FINS and FCP were significantly different among the four subtypes(P<0.05).(4)Comparison of the prevalence of dyslipidemia and its components in each subtype: The prevalence of high TC in SIDD,MARD,SIRD and MOD was 31.62%,20.71%,36.94%,and 14.57%,respectively.The prevalence of high TC in SIRD was higher than that in MARD and MOD(P<0.05),and the prevalence of high TC in SIDD was higher than that in MOD(P<0.05).The prevalence of high TG in SIDD,MARD,SIRD and MOD was 56.62%,43.79%,76.58% and 52.98%,respectively.The prevalence of high TG in SIRD was higher than that in SIDD,MARD and MOD(P<0.05).The prevalence of low HDL-C was 27.94%,31.36%,50.45% and41.72% in SIDD,MARD,SIRD and MOD,respectively.The prevalence of low HDL-C in SIRD was higher than that in SIDD and MARD(P<0.05).The prevalence of high LDL-C was 36.76%,25.44%,38.74% and 20.53% in SIDD,MARD,SIRD and MOD,respectively.The prevalence of high LDL-C in SIDD and SIRD was higher than that in MOD(P<0.05).The prevalence of dyslipidemia in SIDD,MARD,SIRD and MOD was 78.68%,67.46%,91.89% and 73.51%,respectively.The prevalence of dyslipidemia in SIRD was higher than that in SIDD,MARD and MOD(P<0.05).(5)The MARD with a low incidence of dyslipidemia was taken as the baseline group,and whether the newly diagnosed T2 DM patients had dyslipidemia was taken as the dependent variable.The diabetic classification was taken as the independent variable.The logistic regression analysis showed that after adjusting for gender,age,smoking,drinking,SBP,DBP,BMI and Hb A1 c,the risk of dyslipidemia in SIRD was higher than that in MARD(OR=3.647,95% CI: 1.543-8.620,P<0.05).(6)Medication of each subtype:The use rate of metformin in MARD,SIRD and MOD was higher than that in SIDD(P<0.05);the use rate of glinides in SIDD was higher than that in SIRD(P<0.05);the use rate of insulin in SIDD was the highest;the use rate of α-glycosidase inhibitors in SIDD and MARD was higher than that in MOD(P<0.05);the use rate of SGLT-2i in SIRD was higher than that in MARD(P<0.05);GLP-1RA had the highest use rate in SIRD(P<0.05).There was no statistically significant difference in the use rate of sulfonylureas,thiazolidinediones(TZD),dipeptidyl peptidase-4(DPP-4)inhibitors,statins and fibrates among the four subtypes(P>0.05).2.Non-newly diagnosed T2 DM patients:(1)Basic information:438 non-newly diagnosed T2 DM patients were included in this study,with an average age of55.71±10.36 years old.There were 304 males(69.41%)and 134 females(30.59%).The level of TC and HDL-C in females was higher than that in males(P<0.05).There was no significant difference in the level of TG and LDL-C between the two groups(P>0.05).The overall prevalence of dyslipidemia in non-newly diagnosed T2 DM patients was 73.06% and the prevalence of high TC,high TG,low HDL-C and high LDL-C was 22.15%,50.00%,31.96% and 30.37% respectively.The prevalence of females with high TC and high LDL-C(29.10%,37.31%)was higher than that in males(19.08%,27.30%)(P<0.05),and the prevalence of males with low HDL-C(37.83%)was higher than that in females(18.66%)(P<0.05).There was no significant difference in the prevalence of high TG between males(49.67%)and females(50.75%)(P>0.05).(2)Cluster characteristics: 438 non-newly diagnosed T2 DM patients were divided into the following three subtypes: SIDD,MARD and SIRD,each of which accounted for 29.68%,40.41% and 29.91% respectively.For SIDD,low age,low BMI,poor blood glucose control,the lowest IR,the worst β-cell function,and the most serious insulin deficiency.The number of MARD accounts for the largest proportion.It is the oldest among the three subtypes,with moderate BMI,good blood glucose control,moderate IR,and the best β-cell function.SIRD is young,with the highest BMI,poor blood glucose control,the most severe IR and good β-cell function.(3)Comparison of blood lipids and other indicators of each subtype after cluster classification: The level of TC and LDL-C in SIDD was higher than that in MARD(P<0.05);the level of TG in SIRD was higher than that in SIDD and MARD(P<0.05);the level of HDL-C in SIDD was higher than that in SIRD(P<0.05).The proportion of males,age,BMI,Hb A1 c,HOMA2-IR,HOMA2-β,FBG,FINS,FCP,the prevalence of DN and NAFLD were significantly different among the three subtypes(P<0.05).(4)Comparison of the prevalence of dyslipidemia and its components in each subtype:The prevalence of high TC in SIDD,MARD,and SIRD was 31.54%,21.47%,and 13.74%,respectively and the prevalence of high TC in SIDD was higher than that in SIRD(P<0.05);the prevalence of high TG was 44.62%,45.20% and 61.83% in SIDD,MARD and SIRD,respectively and the prevalence of high TG in SIRD was higher than that in SIDD and MARD(P<0.05);the prevalence of low HDL-C,high LDL-C and dyslipidemia was no significant difference among the three subtypes(P>0.05).(5)The MARD with a low incidence of dyslipidemia was taken as the baseline group,and whether the non-newly diagnosed T2 DM patients had dyslipidemia was taken as the dependent variable.The diabetic classification was taken as the independent variable.The logistic regression analysis showed that,compared with MARD,after adjusting the related factors such as gender,age,course,smoking,drinking,SBP,DBP,BMI and Hb A1 c,the risk of dyslipidemia in SIRD had no significant difference(P>0.05).(6)Medication of each subtype: The use rate of metformin in SIDD and SIRD was higher than that in MARD(P<0.05);the use rate of insulin in SIDD and SIRD was higher than that in MARD(P<0.05);the use rate of α-glycosidase inhibitors in SIDD was higher than that in MARD(P<0.05);the use rate of SGLT-2i and GLP-1RA in SIRD was higher than that in SIDD and MARD(P<0.05).There were no significant differences in the use rate of sulfonylureas,TZD,DPP-4 inhibitors,glinides,statins,and fibrates among the three subtypes(P>0.05).Conclusions(1)The new classification of diabetes mellitus proposed by the Swedish team has certain applicability and stability in newly diagnosed T2 DM patients.In non-newly diagnosed T2 DM patients,MOD is missing,which may be related to the migration of this subtype with the progress of the disease.It still needs to be explored in the future.(2)The blood lipid indicators,the prevalence of dyslipidemia and their components varied among the subtypes.Among the newly diagnosed T2 DM patients,there were significant differences in the blood lipid indicators,the prevalence of dyslipidemia and their components among the subtypes.The prevalence of dyslipidemia in newly diagnosed SIRD among all subtypes is the highest,which may be related to its high IR status.(3)The drug use situation of each subtype is different,and different subtypes have drug choices that are more suitable for their own characteristics and conform to the mechanism of drug action. |
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