Characterizing the weight-glycemia phenotypes of type 1 diabetes in youth and young adulthood
Year: 2020
Type: article
Abstract: INTRODUCTION: weight and glycemia and compare characteristics across subgroups. RESEARCH DESIGN AND METHODS: Participants with T1D in the SEARCH study cohort (n=1817, 6.0-30.4 years) were seen at a follow-up visit >5 years after diagnosis. Hierarchical agglomerative clustering was used to group participants based on five measures summarizing the joint distribution of body mass index z-score (BMIz) and hemoglobin A1c (HbA1c) which were estimated by reinforcement learning tree predictions from 28 covariates. Interpretation of cluster weight status and glycemic control was based on mean BMIz and HbA1c, respectively. RESULTS: The sample was 49.5% female and 55.5% non-Hispanic white (NHW); mean±SD age=17.6±4.5 years, T1D duration=7.8±1.9 years, BMIz=0.61±0.94, and HbA1c=76±21 mmol/mol (9.1±1.9)%. Six weight-glycemia clusters were identified, including four normal weight, one overweight, and one subgroup with obesity. No cluster had a mean HbA1c <58 mmol/mol (7.5%). Cluster 1 (34.0%) was normal weight with the lowest HbA1c and comprised 85% NHW participants with the highest socioeconomic position, insulin pump use, dietary quality, and physical activity. Subgroups with very poor glycemic control (ie, ≥108 mmol/mol (≥12.0%); cluster 4, 4.4%, and cluster 5, 7.5%) and obesity (cluster 6, 15.4%) had a lower proportion of NHW youth, lower socioeconomic position, and reported decreased pump use and poorer health behaviors (overall p<0.01). The overweight subgroup with very poor glycemic control (cluster 5) showed the highest lipids and blood pressure (p<0.01). CONCLUSIONS: There are distinct subgroups of youth and young adults with T1D that share weight-glycemia phenotypes. Subgroups may benefit from tailored interventions addressing differences in clinical care, health behaviors, and underlying health inequity.
Authors: Anna R Kahkoska, Crystal T Nguyen, Xiaotong Jiang, Linda A Adair, Shivani Agarwal, Allison E Aiello, Kyle S Burger, John B Buse, Dana Dabelea, Lawrence M Dolan, Giuseppina Imperatore, Jean Marie Lawrence, Santica Marcovina, Catherine Pihoker, Beth A Reboussin, Katherine A Sauder, Michael R Kosorok, Elizabeth J Mayer-Davis
Institutions: University of North Carolina at Chapel Hill, Albert Einstein College of Medicine, Colorado School of Public Health, University of Colorado Anschutz, Cincinnati Children's Hospital Medical Center, Centers for Disease Control and Prevention, Kaiser Permanente, University of Washington, Wake Forest University Health Sciences, Wake Forest University
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,000
Funders: U.S. Department of Veterans Affairs, Kaiser Permanente, Medical University of South Carolina, Wake Forest University, University of Washington, University of Cincinnati, University of South Carolina, Seattle Children's Research Institute, Ohio Department of Health, Georgia Clinical and Translational Science Alliance, National Institutes of Health, Centers for Disease Control and Prevention, University of North Carolina at Chapel Hill, University of Colorado Denver, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Environmental Health Sciences, National Center for Chronic Disease Prevention and Health Promotion, National Center for Advancing Translational Sciences, North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill
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OpenAlex ID: W3003394907