Characterizing the Weight-Glycemia Phenotypes of Type 1 Diabetes in Youth and Young Adulthood

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Kahkoska, Anna R.; Nguyen, Crystal T.; Jiang, Xiaotong; Adair, Linda S.; Agarwal, Shivani; Aiello, Allison E.; Burger, Kyle S.; Buse, John B.; Dabelea, Dana; & Dolan, Lawrence M., et al. (2020). Characterizing the Weight-Glycemia Phenotypes of Type 1 Diabetes in Youth and Young Adulthood. BMJ Open Diabetes Research & Care, 8(1), e000886. PMCID: PMC7039605

Abstract

INTRODUCTION: Individuals with type 1 diabetes (T1D) present with diverse body weight status and degrees of glycemic control, which may warrant different treatment approaches. We sought to identify subgroups sharing phenotypes based on both 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,

URL

http://dx.doi.org/10.1136/bmjdrc-2019-000886

Reference Type

Journal Article

Year Published

2020

Journal Title

BMJ Open Diabetes Research & Care

Author(s)

Kahkoska, Anna R.
Nguyen, Crystal T.
Jiang, Xiaotong
Adair, Linda S.
Agarwal, Shivani
Aiello, Allison E.
Burger, Kyle S.
Buse, John B.
Dabelea, Dana
Dolan, Lawrence M.
Imperatore, Giuseppina
Lawrence, Jean Marie
Marcovina, Santica
Pihoker, Catherine
Reboussin, Beth A.
Sauder, Katherine A.
Kosorok, Michael R.
Mayer-Davis, Elizabeth J.

Article Type

Regular

PMCID

PMC7039605

Data Set/Study

SEARCH for Diabetes in Youth Study

Continent/Country

United States of America

State

Nonspecific

ORCiD

Adair - 0000-0002-3670-8073
Aiello - 0000-0001-7029-2537