Adult-onset diabetes has been categorized into subgroups using clinical variables and clustering approaches, raising questions about differences in long-term outcomes across these groups. In The Lancet Diabetes & Endocrinology, a prospective cohort study from Sweden examined long-term comorbidities and mortality across five adult-onset diabetes subgroups.
The analysis used data from two subsets of the All New Diabetics in Scania (ANDIS) cohort, including individuals aged 18 years or older diagnosed with diabetes and enrolled within one year of diagnosis. Participants were grouped into severe autoimmune diabetes (SAID), severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), mild obesity-related diabetes (MOD), and mild age-related diabetes (MARD) based on glutamic acid decarboxylase antibodies, Homeostasis Model Assessment 2 indices, body mass index (BMI), glycated hemoglobin (HbA1c), and age at diagnosis. Logistic regression and Fine-Gray proportional hazards models were used to assess prevalent and incident comorbidities, with MARD as the comparator.
A total of 19 076 participants were included, with median follow-up of 9.63 years in ANDIS1 and 2.83 years in ANDIS2. SAID and SIDD had the highest HbA1c levels at diagnosis and over time and showed increased risks of retinopathy (adjusted hazard ratio [HR] 1.35 and 2.11, respectively) and neuropathy (HR 2.58 and 2.13). At diagnosis, SIRD had the highest prevalence of hypertension, dyslipidaemia, kidney disease, cardiovascular disease, and steatotic liver disease. Both SIDD and SIRD had increased risks of incident kidney disease, including kidney failure, and myocardial infarction. SIRD and MOD showed higher risks of atrial fibrillation, while stroke risk was increased only in SIDD. SIRD also had higher risks of steatotic liver disease and heart failure.
After adjustment for age, sex, BMI, hypertension, low-density lipoprotein cholesterol, and smoking, total mortality remained higher in SIDD, SIRD, and MOD, largely driven by cardiovascular mortality.
