SEARCHCROSS-SECTIONALendocrinology, epidemiology

cross-sectional·endocrinology, epidemiology, public health, internal medicine, family medicine·PMC10319880

Subgroups of adult-onset diabetes: a data-driven cluster analysis in a Ghanaian population

Scientific Reports · 13 authors, 15 centres

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TL;DR

This study used cluster analysis on clinical data from 541 Ghanaian adults with diabetes to see if subgroups identified in European populations could be reproduced. It found that the same five subgroups could be largely identified, each showing different patterns of diabetic complications.

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This cross-sectional study analyzed data from 541 Ghanaian adults with adult-onset diabetes from the RODAM Study. Researchers applied two data-driven cluster analysis approaches. The first, using variables from a prior European study, reproduced five subgroups: obesity-related (73%), age-related (10%), autoimmune-related (5%), insulin-deficient (7%), and insulin-resistant (5%). The study concludes that cluster analysis can identify meaningful diabetes subgroups in this population using routine clinical data, but notes limitations including the cross-sectional design, reliance on self-reported complications for some outcomes, and the need for prospective validation.

STUDY TYPE

cross-sectional

SPECIALTY

endocrinology

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ORIGINAL PAPER

PMC10319880

Subgroups of adult-onset diabetes: a data-driven cluster analysis in a Ghanaian population

Scientific Reports

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ABSTRACT

Adult-onset diabetes mellitus (here: aDM) is not a uniform disease entity. In European populations, five diabetes subgroups have been identified by cluster analysis using simple clinical variables; these may elucidate diabetes aetiology and disease prognosis. We aimed at reproducing these subgroups among Ghanaians with aDM, and establishing their importance for diabetic complications in different health system contexts. We used data of 541 Ghanaians with aDM (age: 25–70 years; male sex: 44%) from the multi-center, cross-sectional Research on Obesity and Diabetes among African Migrants (RODAM) Study. Adult-onset DM was defined as fasting plasma glucose (FPG) ≥ 7.0 mmol/L, documented use of glucose-lowering medication or self-reported diabetes, and age of onset ≥ 18 years. We derived subgroups by cluster analysis using (i) a previously published set of variables: age at diabetes onset, HbA1c, body mass index, HOMA-beta, HOMA-IR, positivity of glutamic acid decarboxylase autoantibodies (GAD65Ab), and (ii) Ghana-specific variables: age at onset, waist circumference, FPG, and fasting insulin. For each subgroup, we calculated the clinical, treatment-related and morphometric characteristics, and the proportions of objectively measured and self-reported diabetic complications. We reproduced the five subgroups: cluster 1 (obesity-related, 73%) and cluster 5 (insulin-resistant, 5%) with no dominant diabetic complication patterns; cluster 2 (age-related, 10%) characterized by the highest proportions of coronary artery disease (CAD, 18%) and stroke (13%); cluster 3 (autoimmune-related, 5%) showing the highest proportions of kidney dysfunction (40%) and peripheral artery disease (PAD, 14%); and cluster 4 (insulin-deficient, 7%) characterized by the highest proportion of retinopathy (14%). The second approach yielded four subgroups: obesity- and age-related (68%) characterized by the highest proportion of CAD (9%); body fat-related and insulin-resistant (18%) showing the highest proportions of PAD (6%) and stroke (5%); malnutrition-related (8%) exhibiting the lowest mean waist circumference and the highest proportion of retinopathy (20%); and ketosis-prone (6%) with the highest proportion of kidney dysfunction (30%) and urinary ketones (6%). With the same set of clinical variables, the previously published aDM subgroups can largely be reproduced by cluster analysis in this Ghanaian population. This method may generate in-depth understanding of the aetiology and prognosis of aDM, particularly when choosing variables that are clinically relevant for the target population.

CITATION EXPORT

Ina Danquah, Isabel Mank, Christiane S. Hampe et al.. Subgroups of adult-onset diabetes: a data-driven cluster analysis in a Ghanaian population. Scientific Reports. (2023). https://doi.org/10.1038/s41598-023-37494-2

AUTHORS

13 · 15 CENTRES

Ina Danquah, Isabel Mank, Christiane S. Hampe, Karlijn A. C. Meeks, Charles Agyemang, Ellis Owusu-Dabo, Liam Smeeth, Kerstin Klipstein-Grobusch, Silver Bahendeka, Joachim Spranger, Frank P. Mockenhaupt, Matthias B. Schulze, Olov Rolandsson

1grid.7700.00000 0001 2190 4373Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
2grid.516201.10000 0004 6362 7353German Institute for Development Evaluation (DEval), Bonn, Germany
3grid.34477.330000000122986657Department of Medicine, University of Washington, Seattle, WA USA
4grid.94365.3d0000 0001 2297 5165Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD USA
5grid.7177.60000000084992262Department of Public Health, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
6grid.9829.a0000000109466120Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
7grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine (LSHTM), London, UK
8grid.5477.10000000120346234Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
9grid.11951.3d0000 0004 1937 1135Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
10grid.442648.80000 0001 2173 196XMKPGMS-Uganda Martyrs University, Kampala, Uganda
11grid.7468.d0000 0001 2248 7639Department of Endocrinology and Metabolism, Charité - Universitaetsmedizin Berlin, Corporate Member of Freie Universitaet Berlin, Humboldt-Universitaet zu Berlin, Berlin Institute of Health, Berlin, Germany
12grid.6363.00000 0001 2218 4662Institute of Tropical Medicine and International Health, Charité - Universitaetsmedizin Berlin, Corporate Member of Freie Universitaet Berlin, Humboldt-Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
13grid.418213.d0000 0004 0390 0098Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
14grid.11348.3f0000 0001 0942 1117Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
15grid.12650.300000 0001 1034 3451Department of Public Health and Clinical Medicine, Section of Family Medicine, Umeå University, Umeå, Sweden