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, Brian Lu Comprehensive Diabetes Center, Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Alabama at Birmingham Search for other works by this author on: Oxford Academic Peng Li School of Nursing, University of Alabama at Birmingham Search for other works by this author on: Oxford Academic Andrew B Crouse Hugh Kaul Precision Medicine Institute, University of Alabama at Birmingham , Birmingham, AL 35294 , USA Search for other works by this author on: Oxford Academic Tiffany Grimes Comprehensive Diabetes Center, Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Alabama at Birmingham Search for other works by this author on: Oxford Academic Matthew Might Hugh Kaul Precision Medicine Institute, University of Alabama at Birmingham , Birmingham, AL 35294 , USA Search for other works by this author on: Oxford Academic Fernando Ovalle Comprehensive Diabetes Center, Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Alabama at Birmingham Search for other works by this author on: Oxford Academic Anath Shalev Comprehensive Diabetes Center, Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Alabama at Birmingham Corresponding author/reprint requests: Anath Shalev, M.D., Professor and Director, Comprehensive Diabetes Center, University of Alabama at Birmingham, 1825 University Blvd, SHELBY Bldg 1206, Birmingham, AL 35294-2182, Phone: (205) 996-4777, E-mail: shalev@uab.edu Search for other works by this author on: Oxford Academic
https://orcid.org/0000-0002-9026-9999 The Journal of Clinical Endocrinology & Metabolism, dgae516, https://doi.org/10.1210/clinem/dgae516
Published:
30 July 2024
Article history
Received:
16 May 2024
Revision received:
27 June 2024
Editorial decision:
23 July 2024
Accepted:
23 July 2024
Published:
30 July 2024
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Brian Lu, Peng Li, Andrew B Crouse, Tiffany Grimes, Matthew Might, Fernando Ovalle, Anath Shalev, Data-driven Cluster Analysis Reveals Increased Risk for Severe Insulin-Deficient Diabetes in Black/African Americans, The Journal of Clinical Endocrinology & Metabolism, 2024;, dgae516, https://doi.org/10.1210/clinem/dgae516
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Abstract
Context
Diabetes is a heterogenic disease and distinct clusters have emerged, but the implications for diverse populations have remained understudied.
Objective
Apply cluster analysis to a diverse diabetes cohort in the U.S. Deep South.
Design
Retrospective hierarchical cluster analysis of electronic health records from 89,875 patients diagnosed with diabetes between January 1, 2010, and December 31, 2019, at the Kirklin Clinic of the University of Alabama at Birmingham, an ambulatory referral center.
Patients
Adult patients with ICD diabetes codes were selected based on available data for 6 established clustering parameters (GAD-autoantibody; HbA1c; BMI; Diagnosis age; HOMA2-B; HOMA2-IR); ∼42% were Black/African American.
Main Outcome Measure(s)
Diabetes subtypes and their associated characteristics in a diverse adult population based on clustering analysis. We hypothesized that racial background would affect the distribution of subtypes. Outcome and hypothesis were formulated prior to data collection.
Results
Diabetes cluster distribution was significantly different in Black/African Americans compared to Whites (P<0.001). Black/African Americans were more likely to have severe insulin deficient diabetes (SIDD) (OR 1.83, CI 1.36-2.45, P<0.001), associated with more serious metabolic perturbations and a higher risk for complications (OR 1.42, 95% CI 1.06-1.90, P=0.020). Surprisingly, Black/African Americans specifically had more severe impairment of beta cell function (HOMA2-B, C-peptide) (P<0.001), while not being more obese or insulin resistant.
Conclusions
Racial background greatly influences diabetes cluster distribution and Black/African Americans are more frequently and more severely affected by SIDD. This may further help explain the disparity in outcomes and have implications for treatment choice.
Diabetes cluster, Black/African American, Beta cell function, Insulin deficiency, Insulin resistance, Obesity
Accepted manuscripts
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© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. See the journal About page for additional terms.
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