Identifying subtypes of pre-diabetes and type 2 diabetes

Aim and purpose

Type 2 diabetes is defined as a single disease entity regardless of the way it is diagnosed. The pre-diabetic subtypes ‘impaired fasting glycaemia’ and ‘impaired glucose tolerance’ reflect different disease processes, and it is likely that such differences are also present in individuals with type 2 diabetes. However, this remains to be documented.

Even though most clinicians recognise that type 2 diabetes is a multi-factorial disease with diverse characteristics, they have no system for treatment or prevention that acknowledges these differences in disease processes.

In this research project we aim to identify subgroups of individuals with different patterns of disease development before the onset of type 2 diabetes and diabetic complications. Our goal is that information obtained from this project can be used to tailor prevention strategies and treatment guidelines.

Design, method and theory
This on-going study uses data obtained from large-scale epidemiological studies:

1) The Whitehall II study 
2) The Inter99 study 
3) The ADDITION and ADDITION-PRO studies  
We will use novel statistical methods (multilevel longitudinal modelling, latent class trajectory analysis, decision tree analysis) to identify subgroups at risk and patterns of risk factor development.

Target group
Individuals with obesity, pre-diabetes or diabetes.

Expected outcomes
Our goal is that clinicians will use these results to tailor prevention strategies and treatment guidelines for type 2 diabetes.

Funding and collaborators
This project is partly funded by the Steno Innovation Fund.

Whitehall II collaborators:
Mika Kivimäki, UCL, London, UK
Eric Brunner, UCL, London, UK
Adam Tabák, UCL, London, UK
and Semmelweis University, Budapest, Hungary
Daniel Witte, CRP, Luxembourg
Christian Herder, Germany

ADDITION and ADDITION-PRO collaborators:
Torsten Lauritzen, Denmark
Annelli Sandbæk, Denmark
Knut Borch-Johnsen, Holbæk Sygehus, Denmark
Daniel Witte, CRP, Luxembourg
Rebecca Simmons, MRC Epidemiology Unit, Cambridge, UK
Nanna Borup-Johansen, Bispebjerg Hospital, Denmark
Anne-Louise Smidt Hansen, Sydvestjysk Sygehus, Esbjerg, Denmark Inter99 collaborators:
Torben Jørgensen, Research Centre for Prevention and Health, Glostrup Hospital, Denmark Allan Linneberg, Research Centre for Prevention and Health, Glostrup Hospital, Denmark Charlotte Glümer, Research Centre for Prevention and Health, Glostrup Hospital, Denmark Cathrine Lau, Research Centre for Prevention and Health, Glostrup Hospital, Denmark

Other collaborators:
Leigh Perreault, University of Colorado Denver, USA

Papers published related to this project
Færch et al. Trajectories of cardiometabolic risk factors before diagnosis of three subtypes of type 2 diabetes: Post-hoc analysis from the longitudinal Whitehall II cohort study. Lancet Diabetes & Endocrinology, Epub ahead of print (Feb 2013):

Comment by Wild and Byrne. Towards a personalised diagnosis of type 2 diabetes. Lancet Diabetes & Endocrinology, Epub ahead of print (Feb 2013):

Vistisen et al. Sex differences in glucose and insulin trajectories prior to diabetes diagnosis: the Whitehall II study. Acta Diabetologica, Epub ahead of print (Sept 2012):

Sidst opdateret 20-09-2016

Kristine Færch
Senior Researcher
Clinical Epidemiology Research

Dorte Vistisen
Senior Researcher
Clinical Epidemiology Research