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Yacamán Méndez D, Zhou M, Trolle Lagerros Y, Gómez Velasco DV, Tynelius P, Gudjonsdottir H, Ponce de Leon A, Eeg-Olofsson K, Östenson CG, Brynedal B, Aguilar Salinas CA, Ebbevi D, Lager A. Characterization of data-driven clusters in diabetes-free adults and their utility for risk stratification of type 2 diabetes. BMC Med 2022; 20:356. [PMID: 36253773 PMCID: PMC9578256 DOI: 10.1186/s12916-022-02551-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevention of type 2 diabetes is challenging due to the variable effects of risk factors at an individual level. Data-driven methods could be useful to detect more homogeneous groups based on risk factor variability. The aim of this study was to derive characteristic phenotypes using cluster analysis of common risk factors and to assess their utility to stratify the risk of type 2 diabetes. METHODS Data on 7317 diabetes-free adults from Sweden were used in the main analysis and on 2332 diabetes-free adults from Mexico for external validation. Clusters were based on sex, family history of diabetes, educational attainment, fasting blood glucose and insulin levels, estimated insulin resistance and β-cell function, systolic and diastolic blood pressure, and BMI. The risk of type 2 diabetes was assessed using Cox proportional hazards models. The predictive accuracy and long-term stability of the clusters were then compared to different definitions of prediabetes. RESULTS Six risk phenotypes were identified independently in both cohorts: very low-risk (VLR), low-risk low β-cell function (LRLB), low-risk high β-cell function (LRHB), high-risk high blood pressure (HRHBP), high-risk β-cell failure (HRBF), and high-risk insulin-resistant (HRIR). Compared to the LRHB cluster, the VLR and LRLB clusters showed a lower risk, while the HRHBP, HRBF, and HRIR clusters showed a higher risk of developing type 2 diabetes. The high-risk clusters, as a group, had a better predictive accuracy than prediabetes and adequate stability after 20 years. CONCLUSIONS Phenotypes derived using cluster analysis were useful in stratifying the risk of type 2 diabetes among diabetes-free adults in two independent cohorts. These results could be used to develop more precise public health interventions.
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Affiliation(s)
- Diego Yacamán Méndez
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden. .,Center for Epidemiology and Community Medicine (CES), Stockholm Health Care Services, Stockholm, Sweden. .,Obesity Center, Academic Specialist Center, Stockholm Health Care Services, Stockholm, Sweden.
| | - Minhao Zhou
- Center for Epidemiology and Community Medicine (CES), Stockholm Health Care Services, Stockholm, Sweden
| | - Ylva Trolle Lagerros
- Obesity Center, Academic Specialist Center, Stockholm Health Care Services, Stockholm, Sweden.,Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Donaji V Gómez Velasco
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Per Tynelius
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Center for Epidemiology and Community Medicine (CES), Stockholm Health Care Services, Stockholm, Sweden
| | - Hrafnhildur Gudjonsdottir
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Center for Epidemiology and Community Medicine (CES), Stockholm Health Care Services, Stockholm, Sweden
| | - Antonio Ponce de Leon
- Center for Epidemiology and Community Medicine (CES), Stockholm Health Care Services, Stockholm, Sweden
| | - Katarina Eeg-Olofsson
- Department of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Claes-Göran Östenson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Boel Brynedal
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Center for Epidemiology and Community Medicine (CES), Stockholm Health Care Services, Stockholm, Sweden
| | - Carlos A Aguilar Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - David Ebbevi
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Center for Epidemiology and Community Medicine (CES), Stockholm Health Care Services, Stockholm, Sweden
| | - Anton Lager
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Center for Epidemiology and Community Medicine (CES), Stockholm Health Care Services, Stockholm, Sweden
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Almeda-Valdes P, Gómez Velasco DV, Arellano Campos O, Bello-Chavolla OY, Del Rocío Sevilla-González M, Viveros Ruiz T, Martagón Rosado AJ, Bautista CJ, Muñoz Hernandez L, Cruz-Bautista I, Moreno-Macias H, Huerta-Chagoya A, Rodríguez-Álvarez KG, Walford GA, Jacobs SBR, Guillen Pineda LE, Ordoñez-Sánchez ML, Roldan-Valadez E, Azpiroz J, Furuzawa-Carballeda J, Clark P, Herrera-Hernández MF, Zambrano E, Florez JC, Tusié Luna MT, Aguilar-Salinas CA. The SLC16A11 risk haplotype is associated with decreased insulin action, higher transaminases and large-size adipocytes. Eur J Endocrinol 2019; 180:99-107. [PMID: 30475225 DOI: 10.1530/eje-18-0677] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/19/2018] [Indexed: 02/05/2023]
Abstract
Objective A haplotype at chromosome 17p13 that reduces expression and function of the solute carrier transporter SLC16A11 is associated with increased risk for type 2 diabetes in Mexicans. We aim to investigate the detailed metabolic profile of SLC16A11 risk haplotype carriers to identify potential physiological mechanisms explaining the increased type 2 diabetes risk. Design Cross-sectional study. Methods We evaluated carriers (n = 72) and non-carriers (n = 75) of the SLC16A11 risk haplotype, with or without type 2 diabetes. An independent sample of 1069 subjects was used to replicate biochemical findings. The evaluation included euglycemic-hyperinsulinemic clamp, frequently sampled intravenous glucose tolerance test (FSIVGTT), dual-energy X-ray absorptiometry (DXA), MRI and spectroscopy and subcutaneous abdominal adipose tissue biopsies. Results Fat-free mass (FFM)-adjusted M value was lower in carriers of the SLC16A11 risk haplotype after adjusting for age and type 2 diabetes status (β = -0.164, P = 0.04). Subjects with type 2 diabetes and the risk haplotype demonstrated an increase of 8.76 U/L in alanine aminotransferase (ALT) (P = 0.02) and of 7.34 U/L in gamma-glutamyltransferase (GGT) (P = 0.05) compared with non-carriers and after adjusting for gender, age and ancestry. Among women with the risk haplotype and normal BMI, the adipocyte size was higher (P < 0.001). Conclusions Individuals carrying the SLC16A11 risk haplotype exhibited decreased insulin action. Higher serum ALT and GGT levels were found in carriers with type 2 diabetes, and larger adipocytes in subcutaneous fat in the size distribution in carrier women with normal weight.
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Affiliation(s)
- Paloma Almeda-Valdes
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Donaji V Gómez Velasco
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
| | - Olimpia Arellano Campos
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
| | - Omar Yaxmehen Bello-Chavolla
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Magdalena Del Rocío Sevilla-González
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
| | - Tannia Viveros Ruiz
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
| | - Alexandro J Martagón Rosado
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
| | - Claudia J Bautista
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Liliana Muñoz Hernandez
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
| | - Ivette Cruz-Bautista
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
| | - Hortensia Moreno-Macias
- Unidad de Biología Molecular y Medicina Genómica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán/Instituto de Investigaciones Biomédicas UNAM, Mexico City, Mexico
- División de Ciencias Sociales y Humanidades, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | - Alicia Huerta-Chagoya
- Unidad de Biología Molecular y Medicina Genómica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán/Instituto de Investigaciones Biomédicas UNAM, Mexico City, Mexico
| | - Karen Guadalupe Rodríguez-Álvarez
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
| | - Geoffrey A Walford
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Suzanne B R Jacobs
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Luz E Guillen Pineda
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ma Luisa Ordoñez-Sánchez
- Unidad de Biología Molecular y Medicina Genómica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán/Instituto de Investigaciones Biomédicas UNAM, Mexico City, Mexico
| | - Ernesto Roldan-Valadez
- Directorate of Research, Hospital General de Mexico "Dr Eduardo Liceaga", Dr Balmis 148, Col. Doctores, Del. Cuauhtemoc, 06726 Mexico City, Mexico
- Department of Radiology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya str., 8, b. 2, 119992 Moscow, Russia
| | - Joaquín Azpiroz
- Centro Nacional de Investigación en Imagenología e Instrumentación Médica, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | - Jannette Furuzawa-Carballeda
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Patricia Clark
- Unidad de Epidemiología Clínica, Hospital Infantil de México Federico Gómez-Facultad de Medicina Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Miguel F Herrera-Hernández
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Elena Zambrano
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jose C Florez
- Center for Genomic Medicine and Diabetes Research Center (Diabetes Unit), Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - María Teresa Tusié Luna
- Unidad de Biología Molecular y Medicina Genómica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán/Instituto de Investigaciones Biomédicas UNAM, Mexico City, Mexico
| | - Carlos A Aguilar-Salinas
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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