Metabolic phenotypes, vascular complications, and premature deaths in a population of 4,197 patients with type 1 diabetes.
OBJECTIVE
Poor glycemic control, elevated triglycerides, and albuminuria are associated with vascular complications in diabetes. However, few studies have investigated combined associations between metabolic markers, diabetic kidney disease, retinopathy, hypertension, obesity, and mortality. Here, the goal was to reveal previously undetected association patterns between clinical diagnoses and biochemistry in the FinnDiane dataset.


METHODS
At baseline, clinical records, serum, and 24-h urine samples of 2,173 men and 2,024 women with type 1 diabetes were collected. The data were analyzed by the self-organizing map, which is an unsupervised pattern recognition algorithm that produces a two-dimensional layout of the patients based on their multivariate biochemical profiles. At follow-up, the results were compared against all-cause mortality during 6.5 years (295 deaths).


RESULTS
The highest mortality was associated with advanced kidney disease. Other risk factors included 1) a profile of insulin resistance, abdominal obesity, high cholesterol, triglycerides, and low HDL(2) cholesterol, and 2) high adiponectin and high LDL cholesterol for older patients. The highest population-adjusted risk of death was 10.1-fold (95% CI 7.3-13.1) for men and 10.7-fold (7.9-13.7) for women. Nonsignificant risk was observed for a profile with good glycemic control and high HDL(2) cholesterol and for a low cholesterol profile with a short diabetes duration.


CONCLUSIONS
The self-organizing map analysis enabled detailed risk estimates, described the associations between known risk factors and complications, and uncovered statistical patterns difficult to detect by classical methods. The results also suggest that diabetes per se, without an adverse metabolic phenotype, does not contribute to increased mortality.
Department of Biomedical Engineering and Computational Science, Helsinki University of Technology, Helsinki, Finland.
Ville-Petteri
VP
Mäkinen
Carol
C
Forsblom
Lena M
LM
Thorn
Johan
J
Wadén
Daniel
D
Gordin
Outi
O
Heikkilä
Kustaa
K
Hietala
Laura
L
Kyllönen
Janne
J
Kytö
Milla
M
Rosengård-Bärlund
Markku
M
Saraheimo
Nina
N
Tolonen
Maija
M
Parkkonen
Kimmo
K
Kaski
Mika
M
Ala-Korpela
Per-Henrik
PH
Groop
D050153:Abdominal Fat; D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000235:genetics / Q000378:metabolism / Q000401:mortality; D003925:Diabetic Angiopathies / Q000235:genetics / Q000378:metabolism / Q000401:mortality; D004734:Energy Metabolism; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007333:Insulin Resistance; D007674:Kidney Diseases / Q000235:genetics / Q000378:metabolism / Q000401:mortality; D008297:Male; D008499:Medical Records; D024821:Metabolic Syndrome / Q000235:genetics / Q000378:metabolism / Q000401:mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000235:genetics / Q000378:metabolism / Q000401:mortality; D010641:Phenotype; D012307:Risk Factors