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Metabolic Phenotypes, Vascular Complications and Premature Deaths in a Population of 4,197 Patients with Type 1 Diabetes

¹Department of Biomedical Engineering and Computational Science, Helsinki University of Technology, Finland
²Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Finland
³Division of Nephrology, Department of Medicine, Helsinki University Hospital, Finland

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 and serum and 24h-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 (SOM), which is an unsupervised pattern recognition algorithm that produces a two-dimensional layout of the patients based on their multi-variate 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 i) a profile of insulin resistance, abdominal obesity, high cholesterol, triglycerides and low HDL₂C, and ii) high adiponectin and high LDLC 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. Non-significant risk was observed for a profile with good glycemic control and high HDL₂C, and for a low cholesterol profile with a short diabetes duration.

Conclusions: The SOM 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.

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