Background

The subjective experiences of individuals living with diabetes is commonly assessed with patient-reported outcomes (PROs; eg, depression symptoms, wellbeing, health-related quality of life [HRQOL], and diabetes-related distress). Cluster analyses have identified novel diabetes subtypes differing in phenotypic and metabolic characteristics. We aimed to investigate associations between these subtypes and PROs and whether subtype predicted PROs 5 years later.

Methods

Baseline (<12 months after a diabetes diagnosis) and 5-year follow-up data were collected from German Diabetes Study (GDS) participants. Multiple regressions were applied to analyse associations between diabetes subtypes and depression symptoms (Center for Epidemiologic Studies Depression Scale), wellbeing (WHO-5), HRQOL (SF-36), and diabetes-related distress (Problem Areas in Diabetes Scale).

Findings

Cluster analyses at baseline (n=1391) identified participants with severe autoimmune diabetes (SAID, 417 [30%]), severe insulin-deficient diabetes (SIDD, 33 [2%]), severe insulin-resistant diabetes (SIRD, 150 [11%]), mild obesity-related diabetes (MOD, 354 [25%]), and mild age-related diabetes (MARD, 437 [31%]). At baseline, multiple regression analyses showed that participants with SIRD had higher depression symptoms than participants with MARD and lower physical HRQOL than all other subtypes. Participants with SAID reported higher depression symptoms and lower mental HRQOL than participants with MARD, higher physical HRQOL than participants with MARD and MOD, and higher diabetes-related distress than most other subtypes. At the 5-year follow-up, clustering predicted no statistically significant changes in PROs after adjustment for multiple testing, whereas descriptive analyses demonstrated that individuals with SIRD were more likely to experience clinically relevant depression symptoms (16% vs 6%) and low wellbeing (31% vs 14%), respectively, than individuals with MARD.

Interpretation

Diabetes subtypes already differ in PROs at diabetes diagnosis. Our analyses had limited predictive power during follow-up. However, our findings suggest that clustering could predict future changes in depression symptoms.

Funding

The GDS was initiated and financed by the German Diabetes Center, which is funded by the German Federal Ministry of Health, the Ministry of Culture and Science of the state of North Rhine-Westphalia, and by the German Federal Ministry of Education and Research to the German Center for Diabetes Research.

Translation

For the German translation of the abstract see Supplementary Materials section.

中文翻译：

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德国新发糖尿病新亚型的抑郁症状、幸福感、健康相关生活质量和糖尿病相关痛苦：一项为期 5 年的观察性随访研究

 背景

糖尿病患者的主观经历通常与患者报告的结果 （PROs] 进行评估，例如，抑郁症状、幸福感、健康相关生活质量 [HRQOL] 和糖尿病相关痛苦）。聚类分析确定了在表型和代谢特征上不同的新型糖尿病亚型。我们旨在调查这些亚型与 PRO 之间的关联，以及亚型是否能预测 5 年后的 PRO。

 方法

从德国糖尿病研究 （GDS） 参与者那里收集基线 （<糖尿病诊断后 12 个月） 和 5 年随访数据。应用多元回归分析糖尿病亚型与抑郁症状之间的关联 （流行病学研究中心抑郁量表） 、幸福感 （WHO-5） 、HRQOL （SF-36） 和糖尿病相关痛苦 （糖尿病量表中的问题领域）。

 发现

基线时的聚类分析 （n=1391） 确定了患有严重自身免疫性糖尿病 （SAID， 417 [30%]）、严重胰岛素缺乏型糖尿病 （SIDD， 33 [2%]）、严重胰岛素抵抗型糖尿病 （SIRD， 150 [11%]）、轻度肥胖相关糖尿病 （MOD， 354 [25%]） 和轻度年龄相关性糖尿病 （MARD， 437 [31%]）。在基线时，多元回归分析显示，SIRD 参与者的抑郁症状高于 MARD 参与者，身体 HRQOL 低于所有其他亚型。与 MARD 参与者相比，SAID 参与者报告了更高的抑郁症状和更低的精神 HRQOL，比 MARD 和 MOD 参与者更高的身体 HRQOL，以及比大多数其他亚型更高的糖尿病相关痛苦。在 5 年随访中，聚类预测在调整多项测试后 PRO 没有统计学意义变化，而描述性分析表明，SIRD 个体更有可能出现临床相关的抑郁症状 （16% 对 6%） 和低健康状况 （31% 对 14%），分别比 MARD 个体。

 解释

糖尿病亚型在糖尿病诊断时的 PRO 中已经存在差异。我们的分析在随访期间的预测能力有限。然而，我们的研究结果表明，聚类可以预测抑郁症状的未来变化。

 资金

GDS 由德国糖尿病中心发起和资助，该中心由德国联邦卫生部、北莱茵-威斯特法伦州文化和科学部以及德国联邦教育和研究部对德国糖尿病研究中心资助。

 译本

有关摘要的德文翻译，请参见补充材料部分。