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Distinction of cardiometabolic profiles among people ≥75 years with type 2 diabetes: a latent profile analysis.
BMC Endocrine Disorders ( IF 2.8 ) Pub Date : 2019-08-05 , DOI: 10.1186/s12902-019-0411-2
Antoine Christiaens 1, 2, 3 , Michel P Hermans 4, 5 , Benoit Boland 3, 6 , Séverine Henrard 2, 3
Affiliation  

BACKGROUND Older patients with type 2 diabetes mellitus represent a heterogeneous group in terms of metabolic profile. It makes glucose-lowering-therapy (GLT) complex to manage, as it needs to be individualised according to the patient profile. This study aimed to identify and characterize subgroups existing among older patients with diabetes. METHODS Retrospective observational cohort study of outpatients followed in a Belgian diabetes clinic. Included participants were all aged ≥75 years, diagnosed with type 2 diabetes, Caucasian, and had a Homeostasis Model Assessment (HOMA2). A latent profile analysis was conducted to classify patients using the age at diabetes diagnosis and HOMA2 variables, i.e. insulin sensitivity (HOMA2%-S), beta-cell-function (HOMA2%-β), and the product between both (HOMA2%-βxS; as a measure of residual beta-cell function). GLT was expressed in defined daily dose (DDD). RESULTS In total, 147 patients were included (median age: 80 years; 37.4% women; median age at diabetes diagnostic: 62 years). The resulting model classified patients into 6 distinct cardiometabolic profiles. Patients in profiles 1 and 2 had an older age at diabetes diagnosis (median: 68 years) and a lesser decrease in HOMA2%-S, as compared to other profiles. They also presented with the highest HOMA2%-βxS values. Patients in profiles 3, 4 and 5 had a moderate decrease in HOMA2%-βxS. Patients in profile 6 had the largest decrease in HOMA2%-β and HOMA2%-βxS. This classification was associated with significant differences in terms of HbA1c values and GLT total DDD between profiles. Thus, patients in profiles 1 and 2 presented with the lowest HbA1c values (median: 6.5%) though they received the lightest GLT (median GLT DDD: 0.75). Patients in profiles 3 to 5 presented with intermediate values of HbA1c (median: 7.3% and GLT DDD (median: 1.31). Finally, patients in profile 6 had the highest HbA1c values (median: 8.4%) despite receiving the highest GLT DDD (median: 2.28). Other metabolic differences were found between profiles. CONCLUSIONS This study identified 6 groups among patients ≥75 years with type 2 diabetes by latent profile analysis, based on age at diabetes diagnosis, insulin sensitivity, absolute and residual β-cell function. Intensity and choice of GLT should be adapted on this basis in addition to other existing recommendations for treatment individualisation.

中文翻译:

≥75岁的2型糖尿病患者的心脏代谢特征的区分:潜在特征分析。

背景技术根据代谢谱,年龄较大的2型糖尿病患者代表异质性人群。由于需要根据患者情况进行个性化设置,因此它使降糖治疗(GLT)的管理变得复杂。这项研究旨在确定和表征老年糖尿病患者中存在的亚组。方法对比利时糖尿病门诊的门诊患者进行回顾性观察队列研究。参加者均为年龄≥75岁,被诊断患有2型糖尿病的白种人,并进行了稳态模型评估(HOMA2)。进行了潜伏性分析以使用糖尿病诊断时的年龄和HOMA2变量对患者进行分类,即胰岛素敏感性(HOMA2%-S),β细胞功能(HOMA2%-β)以及两者之间的乘积(HOMA2%- βxS; 作为残余β细胞功能的量度)。GLT以规定的每日剂量(DDD)表示。结果总共纳入147例患者(中位年龄:80岁;女性37.4%;糖尿病诊断中位年龄:62岁)。所得模型将患者分为6种不同的心脏代谢曲线。与其他配置文件相比,配置文件1和2的患者在诊断出糖尿病时年龄更大(中位数为68岁),而HOMA2%-S的下降幅度较小。他们还表现出最高的HOMA2%-βxS值。轮廓3、4和5的患者的HOMA2%-βxS轻度下降。资料6中的患者HOMA2%-β和HOMA2%-βxS下降幅度最大。此分类与配置文件之间的HbA1c值和GLT总DDD的显着差异相关。因此,尽管配置文件1和2中的患者接受了最轻的GLT(中位数GLT DDD:0.75),但他们的HbA1c值最低(中位数:6.5%)。概况3至5的患者呈现HbA1c(中位数:7.3%)和GLT DDD(中位数:1.31)的中间值。最后,概况6的患者尽管接受了最高的GLT DDD仍具有最高的HbA1c值(中位数:8.4%)(中位数:2.28)结论之间的差异还存在其他代谢差异结论本研究根据糖尿病诊断的年龄,胰岛素敏感性,绝对和残余β细胞功能,通过潜伏特征分析在≥75岁的2型糖尿病患者中确定了6组。除了其他针对治疗个体化的现有建议外,还应在此基础上调整GLT的强度和选择。5%),尽管他们获得了最轻的GLT(中位数GLT DDD:0.75)。概况3至5的患者呈现中等水平的HbA1c(中位数:7.3%,GLT DDD(中位数:1.31)。最后,概况6的患者尽管接受了最高的GLT DDD,但其HbA1c值最高(中位数:8.4%)。中位数:2.28)结论之间的差异还存在其他代谢差异结论本研究根据糖尿病诊断的年龄,胰岛素敏感性,绝对和残余β细胞功能,通过潜伏特征分析在≥75岁的2型糖尿病患者中确定了6组。除了其他针对治疗个体化的现有建议外,还应在此基础上调整GLT的强度和选择。5%),尽管他们获得了最轻的GLT(中位数GLT DDD:0.75)。概况3至5的患者呈现HbA1c(中位数:7.3%)和GLT DDD(中位数:1.31)的中间值。最后,概况6的患者尽管接受了最高的GLT DDD仍具有最高的HbA1c值(中位数:8.4%)(中位数:2.28)结论之间的差异还存在其他代谢差异结论本研究根据糖尿病诊断的年龄,胰岛素敏感性,绝对和残余β细胞功能,通过潜伏特征分析在≥75岁的2型糖尿病患者中确定了6组。除了其他针对治疗个体化的现有建议外,还应在此基础上调整GLT的强度和选择。尽管接受了最高的GLT DDD(中位数:2.28),配置文件6中的患者仍具有最高的HbA1c值(中位数:8.4%)。在谱图之间发现其他代谢差异。结论本研究根据潜在年龄,糖尿病诊断,胰岛素敏感性,绝对和残留β细胞功能,通过潜在特征分析在≥75岁的2型糖尿病患者中确定了6组。除了针对治疗个体化的其他现有建议外,还应在此基础上调整GLT的强度和选择。尽管接受了最高的GLT DDD(中位数:2.28),配置文件6中的患者仍具有最高的HbA1c值(中位数:8.4%)。在谱图之间发现其他代谢差异。结论根据潜在年龄分析,本研究根据糖尿病诊断年龄,胰岛素敏感性,绝对和残留β细胞功能,在2型糖尿病≥75岁患者中确定了6组。除了针对治疗个体化的其他现有建议外,还应在此基础上调整GLT的强度和选择。胰岛素敏感性,绝对和残留β细胞功能。除了针对治疗个体化的其他现有建议外,还应在此基础上调整GLT的强度和选择。胰岛素敏感性,绝对和残留β细胞功能。除了针对治疗个体化的其他现有建议外,还应在此基础上调整GLT的强度和选择。
更新日期:2019-08-05
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