Metabolic phenotypes, vascular complications, and premature deaths in a population of 4,197 patients with type 1 diabetes

Ville Petteri Mäkinen, Carol Forsblom, Lena M. Thorn, Johan Wadén, Daniel Gordin, Outi Heikkilä, Kustaa Hietala, Laura Kyllönen, Janne Kytö, Milla Rosengård-Bärlund, Markku Saraheimo, Nina Tolonen, Maija Parkkonen, Kimmo Kaski, Mika Ala-Korpela, Per Henrik Groop

Research output: Contribution to journalArticlepeer-review

72 Citations (Scopus)

Abstract

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. RESEARCH DESIGN AND 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 HDL2 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 HDL2 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.

Original languageEnglish
Pages (from-to)2480-2487
Number of pages8
JournalDiabetes
Volume57
Issue number9
DOIs
Publication statusPublished or Issued - Sep 2008
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

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