Background: Serum electrolytes were found to associate with type 2 diabetes. Our study aimed to stratify nondiabetes by clusters based on multiple serum electrolytes and evaluate their associations with risk of developing diabetes and longitudinal changes in glucose and lipid metabolic traits.
Methods: We performed a data-driven cluster analysis in 4937 nondiabetes individuals aged ≥40 years at baseline from a cohort follow-up for an average of 4.4 years. Cluster analysis was based on seven commonly measured serum electrolytes (iron, chlorine, magnesium, sodium, potassium, calcium, and phosphorus) by using the k-means method.
Results: A total of 4937 nondiabetes individuals were classified into three distinct clusters, with 1635 (33.1%) assigned to Cluster A, 1490 (30.2%) to Cluster B, and 1812 (36.7%) to Cluster C. Individuals in Cluster A had higher serum chlorine, were older, and more were women. Individuals in Cluster B had higher serum iron and body mass index (BMI). Individuals in Cluster C had higher serum phosphorus, were younger, and had lower BMI. Cluster B had 1.41-fold higher risk of developing diabetes and Cluster C's risk was 1.33-fold higher compared with Cluster A. Over an average follow-up of 4.4 years, Cluster A showed a moderate and stable BMI, Cluster B showed an accelerated deterioration in glucose metabolism, and Cluster C showed the most sharply increased serum low-density lipoprotein cholesterol level.
Conclusions: Clusters based on seven common serum electrolytes differed in diabetes risk and progression of glucose and lipid metabolic traits. Serum electrolytes clusters could provide a powerful tool to differentiate individuals into different risk stratification for developing type 2 diabetes.
背景: 既往研究发现血清电解质水平与2型糖尿病相关。本研究旨在综合考虑临床常用多种血清电解质, 并对其进行聚类分析, 研究不同血清电解质聚类人群(簇)的临床表型特点, 不同血清电解质簇人群的糖尿病发生风险及糖脂代谢纵向进展变化特征。 方法: 研究纳入4937名40岁及以上基线非糖尿病社区人群, 平均随访4.4年。采用k-means法对基线常规检测的7种血清电解质(铁, 氯, 镁, 钠, 钾, 钙和磷)进行数据驱动的聚类分析。 结果: 基于聚类分析的结果, 4937名基线非糖尿病人群被分为3个不同电解质簇, 1635人(33.1%)分配到簇A人群, 1490人(30.2%)分配到簇B, 1812人(36.7%)分配到簇C。簇A人群基线血清氯水平较高, 年龄较大且女性居多, 簇B人群血清铁及体重指数(body mass index, BMI)水平较高, 簇C人群血清磷水平较高, 年龄偏轻及BMI水平低。以簇A作为参照, 簇B的糖尿病发病风险增加41%(OR=1.41, 95%CI 1.09-1.82), 簇C的糖尿病发病风险增加33% (OR 1.33, 95%CI 1.03-1.71)。平均4.4年随访期间, 簇A人群保持稳定且中等水平的BMI(25 kg/m2 ), 簇B表现出糖代谢的快速恶化, 簇C血清低密度脂蛋白胆固醇(LDL- C)水平急剧上升。 结论: 基于7种常见血清电解质水平的聚类人群在糖尿病发病风险和糖脂代谢异常进展方面存在显著差异。血清电解质簇提供了一个对个体疾病风险分层的强有力工具, 为2型糖尿病及其相关代谢异常的早期预防提供依据。.
Keywords: 2型糖尿病; cluster analysis; metabolic risk; risk stratification; serum electrolytes; type 2 diabetes; 代谢风险; 危险分层; 聚类分析; 血清电解质.
© 2021 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai JiaoTong University School of Medicine and John Wiley & Sons Australia, Ltd.