Characteristics Of Cluster Classifications Of Patients With Newly Diagnosed Type 2 Diabetes Mellitus And Analysis Of Some Chronic Comorbidities

Objective: Based on the newly diagnosed patients with type 2 diabetes mellitus(T2DM),this study analyzed the characteristics of each subgroup under clustering,the o ccurrence of some chronic comorbidities,and influencing factors of comorbidities to promote the accurate classification and corresponding treatments of diabetes and achi eve precise treatments of diabetes and early prevention and treatment of chronic como rbidities.Methods: The basic data are from 547 newly diagnosed T2 DM patients hospitali zed in the Department of Endocrinology and Metabolism of the Second Hospital of La nzhou University from May 2019 to August 2022.All study subjects were obtained,in cluding age,sex,height,weight,heart rate(HR),systolic blood pressure(SBP),diastoli c blood pressure(DBP),smoking history,hypertension history,glycated hemoglobin(Hb A1c),blood glucose and islet function indicators,bone density(BMD),carotid inti mal middle layer thickness(IMT),Vibratory sensory threshold(VPT),ankle-brachial in dex(ABI),blood routine index,biochemical index,and clinical comorbidities.Accordi ng to Hb A1 c,body mass index(BMI),age,insulin resistance index(HOMA2-IR)eval uated by the homeostatic model,and β cell function index(HOMA2-β)evaluated by st eady-state model,different subgroups were obtained by using SPSS 25.0 statistical sof tware,and analyzed the above data,the difference was considered to be statistically si gnificant at P<0.05.Results:(1)Cluster classifications results of newly diagnosed T2 DM patients: We have four subgroups(n=547)after K-means clustering: severe insulin deficiency group(SIDD),severe insulin resistance group(SIRD),mild obesity-related group(MOD),an d mild age-related group(MARD).The proportions of each subgroup were 25.78%,18.65%,24.86%,and 30.71%,respectively.After clustering according to gender stratifica tion,the SIDD group,SIRD group,MOD group,and MARD group accounted for 31.82%,17.91%,23.66%,and 26.61% of the women,respectively.Among the men,the SI DD group,SIRD group,MOD group,and MARD group accounted for 25.33%,23.47%,22.93%,and 28.27%,respectively.(2)Comparison of the characteristics of each subgroup under the cluster classifica tion of newly diagnosed T2 DM patients:age,weight,BMI,HR,SBP,DBP,history of hyp ertension,fasting blood glucose(FPG),fasting insulin(FINS),fasting C-peptide(FCP),bl ood glucose 2 hours after prandial(2h PG),2 hours after prandial insulin(2h INS),2 hour s after prandial C peptide(2h CP),Hb A1 c,HOMA2-β,HOMA2-IR,alkaline phosphatase(ALP),serum free triiodothyronine(FT3),serum free tetraiodothyronine(FT4),Urea(Ur ea),uric acid(UA),creatinine(SCr),total cholesterol(TC),triglycerides(TG),low-density lipoprotein(LDL),high-density lipoprotein(HDL),monocytes/high-density lipoprotein(MHR),triglycerides/high-density lipoprotein(TG/HDL),triglyceride glucose index(Ty G),Alanine aminotransferase(ALT),glutamate aminotransferase(AST),lactate dehyd rogenase(LDH),platelet distribution width(PDW),Mean platelet volume(MPV),erythr ocytes(RBC),hemoglobin(Hb),mean erythrocyte volume(MCV),red blood cell distrib ution width(RDW),and VPT were significantly different among subgroups(P<0.05),an d nonalcoholic fatty liver disease(NAFLD),chronic kidney disease(CKD),and atherosc lerotic cardiovascular disease(ASCVD)were significantly different among the subgro ups(P<0.05).After clustering by sex,the prevalence of NAFLD was highest in the SI RD group in male patients.The prevalence of ASCVD was highest in the MOD grou p;The prevalence of PVD(peripheral vascular disease)is highest in the MARD group.The prevalence of ASCVD was highest in the SIDD group in women(P<0.05).(3)Multiple linear regression analysis of Hb A1 c and related factors in patients wit h newly diagnosed T2 DM showed that FPG(β=0.428,P<0.001),2h CP(β=-0.304,P<0.001),HOMA2-β(β=-0.157,P<0.05),2h INS(β=-0.147,P<0.001),2h PG(β=0.101,P<0.05),TC(β=0.090,P<0.05),MLR(β=0.062,P<0.05)were the influencing factors of Hb A1 c,o f which FPG,2h PG,TC,MLR(monocytes/lymphocytes)were positive influencing facto rs,and 2h CP,2h INS and HOMA2-β were negative influencing factors.(4)Logistic regression in patients with newly diagnosed T2 DM complicated with peripheral neuropathy(DPN)showed that after adjusting for confounding factors,smo king history(OR=4.350,95%CI:1.283～14.751),indirect bilirubin(IBIL)(β=1.071,95%CI:1.001～1.146),serum globulin(GLB)(β=1.046,95%CI:1.001～1.094)were independ ent risk factors for DPN(P<0.05),DBP(β=0.962,95%CI:0.934～0.991,P<0.05)was an independent protective factor for combined DPN,and the area under the receiver ope rating characteristic curve(ROC)of newly diagnosed T2 DM patients with DPN was 0.724;Logistic regression of patients with newly diagnosed T2 DM complicated with C KD showed that after adjusting for confounding factors,height(OR=1.026,95% CI:1.003～1.050),BMI(OR=1.056,95% CI: 1.002 ～1.113),SBP(OR=1.024,95% CI: 1.014 ～1.034),direct bilirubin(DBIL)(OR=1.165,95% CI: 1.072 ～1.266),Ty G(OR=1.307,95% CI: 1.042～1.639)were independent risk factors for CKD(P<0.05),and th e area under the ROC curve of newly diagnosed T2 DM patients with CKD was 0.667;Logistic regression in patients with newly diagnosed T2 DM with retinopathy(DR)sh owed that IBIL(OR=1.055,95% CI: 1.010～1.101)was an independent risk factor(P<0.05)for DR after adjusting for confounding factors,and the area under the ROC curv e for evaluating DR in patients with newly diagnosed T2 DM was 0.554;Logistic regr ession of patients with newly diagnosed T2 DM with PVD showed that after adjusting for confounding factors,hypertension history(OR=2.772,95% CI: 1.647～4.665),SB P(OR=1.013,95% CI: 1.002 ～1.023),urea(Urea)(OR=1.188,95% CI: 1.036 ～1.362)were independent risk factors for PVD(P<0.05),2h PG(OR=0.962,95% CI: 0.930(0.994),TG/HDL(OR=0.900,95% CI: 0.834～0.972),alanine aminotransferase(AL T)(OR=0.988,95% CI: 0.979 ～0.997)were independent protective factors(P<0.05)o f PVD,and the ROC curve area under the newly diagnosed T2 DM patients with PVD was 0.729;Logistic regression in patients with newly diagnosed T2 DM with ASCVD showed that after adjusting for confounding factors,2h INS(OR = 1.017,95% CI: 1.009～1.025)was independent risk factor for ASCVD(P<0.05),blood phosphorus(P)(OR=0.053,95% CI: 0.005～0.520)was independent protective factor(P<0.05)combi ned with ASCVD,and the area under the ROC curve of newly diagnosed T2 DM patie nts with ASCVD was 0.786;Logistic regression of patients with newly diagnosed T2 DM combined with NAFLD showed that after adjusting for confounding factors,BMI(OR=1.187,95% CI: 1.108～1.273),2h CP(OR=2.078,95% CI: 1.465～2.946),ALT(OR=1.039,95% CI: 1.024 ～1.055),Ty G(OR=1.420,95% CI: 1.088～1.853)LDL(O R=1.273,95%CI: 1.015～1.598)were independent risk factors for NAFLD(P<0.05),e rythrocrit(HCT)(OR=0.001,95% CI: 0.002～0.125)was an independent protective fa ctor(P<0.05)for NAFLD,and the area under the ROC curve of newly diagnosed T2 DM patients with NAFLD was 0.802.Conclusions:(1)The classification method proposed by Ahlqvist’s team is still app licable to patients with newly diagnosed T2 DM in this study,but the proportion of sub groups and the overall results under sex clustering stratification are different;There w ere differences in the comparison of indicators in different subgroups.(2)FPG,2h PG,TC and MLR positively affected the Hb A1 c level of newly diagn osed T2 DM patients;2h CP,2h INS,and HOMA2-β negatively affect Hb A1 c levels in patients with newly diagnosed T2 DM.(3)Height,weight,BMI,smoking history,hypertension history,SBP,DBP,IBIL,DBIL,ALT,GLB,P,FT3,FT4,2h PG,2h INS,2h CP,TG/HDL,Ty G,LDL,Urea,HCT a re related to the occurrence of chronic comorbidities in newly diagnosed T2 DM patie nts.