摘要
目的基于糖代谢相关因素,对空腹血糖(fasting plasma glucose,FPG)正常的男性和女性分别进行聚类分析,并评价不同聚类组与2型糖尿病(type 2 diabetes mellitus,T2DM)发病风险的关系。方法选取句容市队列研究基线FPG<6.1 mmol/L的研究对象,分别对2857名男性和4398名女性进行层次K-means(hierarchical K-means,HK-means)聚类分析,聚类变量包括年龄、FPG、稳态模型评估胰岛素分泌指数与抵抗指数、三酰甘油、上颈围、腰围身高比及体力活动指数。采用Kaplan-Meier曲线和Cox比例风险回归模型分析评估聚类组的T2DM绝对和相对发病风险。结果男女人群分别被分为具有不同表型特征及T2DM发病风险的5个聚类组(cluster)。男性cluster 1体质指数(body mass index,BMI)水平最低和年龄最高,cluster 2体力活动指数最高,cluster 3 BMI水平最高且体力活动指数最低,cluster 4表现出高胰岛素抵抗且胰岛β细胞代偿分泌的特征,cluster 5年龄最低但血脂异常。女性cluster 1、2和4与男性特征相似,cluster 3年龄最低,cluster 5体力活动指数最低且肥胖伴随血脂异常。与男性cluster 1相比,cluster 3和4的T2DM发病风险增加了1.28和0.87倍(均P<0.05);调整协变量后,HR(95%CI)分别为1.651(0.927~2.939)与1.516(0.779~2.950),差异均无统计学意义(均P>0.05)。相比于女性cluster 1,cluster 3 T2DM发病风险较低,调整后HR(95%CI)为0.380(0.205~0.704);Cluster 5 T2DM的发病风险较高(P<0.05),调整协变量后差异无统计学意义(HR=1.172,95%CI:0.717~1.916)。结论FPG正常的人群在未诊断为糖尿病时即存在生理代谢异质性,其聚类表型特征呈现出一定的男女性别差异。基于糖代谢相关因素在非糖尿病人群中进行聚类,有助于提高高危亚组的早期筛查和防控干预。
Objective We did cluster analysis in male and female populations with normal fasting plasma glucose based on factors related to glycemic metabolism,and evaluated the association between cluster allocation and the risk of type 2 diabetes mellitus(T2DM).Methods The study population consisted of baseline participants with fasting plasma glucose<6.1 mmol/L from a prospective cohort in Jurong City.Hierarchical K-means clustering was conducted separately for 2857 males and 4398 females.Cluster variables included age,fasting plasma glucose,the homeostasis model assessment 2 estimates of β-cell function and insulin resistance,triglyceride,upper neck circumference,waist-to-height ratio,and physical activity index.The Kaplan-Meier curve for cumulative hazard was used to estimate the incidence of T2DM in male and female clusters.Cox proportional hazard regression model was applied to assess the association between cluster allocation and T2DM risk.Results The male and female populations were classified into 5 distinctive clusters,respectively,with various phenotypic characteristics and different incidence of T2DM.Male cluster 1 had the lowest body mass index(BMI)but the highest age,and cluster 2 had the highest level of physical activity.Male cluster 3 had the highest BMI and the lowest level of physical activity.Cluster 4 was characterized by high insulin resistance and compensatoryβ-cell secretion,while cluster 5 exhibited a phenotype of young age and severe dyslipidemia.Female cluster 1,2,and 4 were similar to those of males.Female cluster 3 had the lowest age,while cluster 5 presented features of the lowest physical activity,obesity,and dyslipidemia.Compared with male cluster 1,the risk of T2DM in cluster 3 and 4 increased by 1.28 times and 0.87 times respectively(all P<0.05).After adjusting for covariates,the HR(95%CI)were 1.651(0.927-2.939)and 1.516(0.779-2.950)with no statistical significance(all P>0.05).Compared to female cluster 1,cluster 3 had a lower risk of developing T2DM,with an adjusted HR(95%CI)of 0.380(0.205-0.704).Cluster 5 had a higher risk of T2DM than cluster 1(P<0.05),but the association was not significant after adjusting for covariates(HR=1.172,95%CI:0.717-1.916).Conclusions Our findings indicate that heterogeneity of physiological metabolism exists among individuals with normal fasting plasma glucose before the diagnosis of T2DM.The clustering phenotypic characteristics also present certain gender differences.Cluster analysis for non-diabetic populations based on glycometabolism-related factors could aid in the improvement of early detection and screening for high-risk subgroups,as well as precise intervention to effectively reduce the risk of diabetes and complications.
作者
马睿
陈逸超
谢涵坤
刘宇
樊垚
唐伟
沈冲
MA Rui;CHEN Yichao;XIE Hankun;LIU Yu;FAN Yao;TANG Wei;SHEN Chong(Department of Epidemiology,School of Public Health,Nanjing Medical University,Nanjing 211166,China;Center for Disease Control and Prevention of Jurong City,Zhenjiang 212499,China;Development of Clinical Epidemiology,Geriatric Hospital Affiliated to Nanjing Medical University,Nanjing 210024,China;Department of Endocrinology,Geriatric Hospital of Nanjing Medical University,Nanjing 210024,China)
出处
《中华疾病控制杂志》
CAS
CSCD
北大核心
2023年第12期1413-1420,1441,共9页
Chinese Journal of Disease Control & Prevention
基金
国家重点研发计划(2018YFC2000703)
国家自然科学基金(82173611)。
关键词
空腹血糖
2型糖尿病
聚类分析
糖代谢
Fasting plasma glucosee
Type 2 diabetes mellitus
Cluster analysis
Glucose metabolism
