RT Journal Article SR Electronic T1 Trends in prevalence of diabetes subgroups in U.S. adults: A data-driven cluster analysis spanning three decades from NHANES (1988-2018) JF medRxiv FD Cold Spring Harbor Laboratory Press SP 2020.12.10.20247452 DO 10.1101/2020.12.10.20247452 A1 Antonio-Villa, Neftali Eduardo A1 Fernandez-Chirino, Luisa A1 Vargas-Vázquez, Arsenio A1 Bahena-Lopez, Jessica Paola A1 Aguilar-Salinas, Carlos A. A1 Bello-Chavolla, Omar Yaxmehen YR 2020 UL http://medrxiv.org/content/early/2020/12/11/2020.12.10.20247452.abstract AB AIMS Data-driven diabetes subgroups have been proposed as an alternative to address diabetes heterogeneity; changes in trends for these subgroups have not previously been reported. Here, we analyzed trends of diabetes subgroups, stratified by sex, race, education level, and age categories in the U.S.METHODS We used data from consecutive NHANES cycles spanning the 1988-2018 period. Diabetes subgroups (mild obesity-related [MOD], severe-insulin deficient [SIID], severe-insulin resistant [SIRD], and age-related diabetes [MARD]) were classified using self-normalizing neural networks. SAID was assessed for NHANES-III cycles. Prevalence was estimated using examination sample weights considering 2-year cycles (biannual change [B.C.]) to evaluate trends.RESULTS Diabetes prevalence in the US increased from 7.5% (95%CI 7.1-7.9) in 1988-1989 to 13.9% (95%CI 13.4-14.4) in 2016-2018 (BC 1.09%, 95%CI 0.98-1.31, p<0.001). Non-Hispanic Blacks had the highest prevalence. Overall, MOD, MARD, and SIID had the highest increase during the studied period. Non-Hispanic Blacks had a sharp increase in MARD and SIID, Mexican Americans in SIID, and non-Hispanic Whites in MARD. Males, subjects with primary school/no-education, and adults aged 40-64 years had the highest increase in MOD prevalence. Trends in diabetes subgroups sustained after stratification by body-mass index categories.CONCLUSIONS The prevalence of diabetes and its data-driven subgroups in the U.S. has increased from 1988-2018. These trends were different across sex, ethnicities, education, and age categories, indicating significant heterogeneity in diabetes within the U.S. Sex-specific factors, population aging, and socioeconomic aspects, together with obesity prevalence increase, could be implicated in the uprising trends of diabetes in the U.S.What is already known about this subject?Diabetes is a heterogeneous disease with increasing prevalence worldwide.An approach to characterize diabetes heterogeneity uses data-driven subgroups, including mild obesity-related (MOD), severe-insulin deficient (SIID), severe-insulin resistant (SIRD), severe autoimmune (SAID) and age-related diabetes (MARD).Prevalence trends of data-driven diabetes subgroups in the U.S. remain as an area of opportunity to assess diabetes heterogeneity over time in the U.S.What is the key question?What are the diabetes subgroup prevalence trends in adult subjects from the National Health and Nutrition Examination Survey in the U.S. from 1988 to 2018?What are the new findings?Diabetes prevalence in the U.S. has steadily increased from 1988 to 2018, with Non-Hispanic Blacks and Mexican Americans having the highest diabetes prevalence.MOD, MARD, and SIID had the highest increase during the studied period; SIRD and SAID remained unchanged.Males, subjects with primary school/no-education, and adults aged 40-64 years had sharp increases in MOD.How might this impact on clinical practice in the foreseeable future?The increase in specific diabetes subgroups could help to implement tailored preventive measures depending on age and ethnicity. Targeted treatment and public health measures should be informed using clinical characteristics for each subgroup.Competing Interest StatementThe authors have declared no competing interest.Funding StatementThis research received no specific funding.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:NHANES had the approval of the NCHS Ethics Review BoardAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesAll data sources and R code are available for reproducibility of results at: https://github.com/oyaxbell/clusters_nhanes