{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T15:12:40Z","timestamp":1780585960496,"version":"3.54.1"},"reference-count":50,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002920","name":"Research Grants Council, University Grants Committee","doi-asserted-by":"publisher","award":["14121723"],"award-info":[{"award-number":["14121723"]}],"id":[{"id":"10.13039\/501100002920","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Diabetologia"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims\/hypothesis<\/jats:title>\n                    <jats:p>Chronic kidney disease (CKD) represents a major and costly comorbidity in type 2 diabetes management. Identifying individuals with high healthcare costs due to CKD will support decision-making for early intervention. We used latent class analysis (LCA) to classify Chinese individuals with type 2 diabetes and incident CKD based on their demographic and clinical profiles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>For this study, 2886 individuals with type 2 diabetes and incident CKD and complete data for 42 attributes were selected from the prospective Hong Kong Diabetes Register cohort (2007\u20132019). We used LCA to select 14 variables to classify participants, followed by a hierarchical generalised linear mixed model to evaluate longitudinal healthcare costs among class memberships.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During 109,784 person-years of follow-up, the incidence of CKD was 26.29 per 1000 person-years with a per-patient-per-year (PPPY) cost of US$4395\u00a0\u00b1\u00a011,947 (mean\u00a0\u00b1\u00a0standard deviation). The four distinct classes used in the LCA based on baseline profiles were as follows: Class 1 (18.3%; PPPY: US$6087\u00a0\u00b1\u00a015,519), namely those who were young at onset (44.4\u00a0\u00b1\u00a010.3 years), had moderate comorbidities (25.6% had a moderate or high score on the Elixhauser Comorbidity Index [ECI]) and used multiple medications (90.2% used at least three medications); Class 2 (21.2%; PPPY: US$3822\u00a0\u00b1\u00a09816), namely those who had old-age onset (66.9\u00a0\u00b1\u00a06.9 years), had moderate comorbidities (27.8% had a moderate or high ECI score) and used multiple medications (70.7% used at least three medications); Class 3 (33.9%; PPPY: US$4260\u00a0\u00b1\u00a011,725), namely those who were middle-aged at onset (54.2\u00a0\u00b1\u00a010.0 years), had few comorbidities (14.0% had a moderate or high ECI score) and used few medications (15.6% used at least three medications); and Class 4 (26.5%; PPPY: US$3923\u00a0\u00b1\u00a010,957), namely those who were middle-aged at onset (54.1\u00a0\u00b1\u00a07.6 years), had moderate comorbidities (25.3% had a moderate or high ECI score) and used multiple medications (98.9% used at least three medications). Class 1 (young onset) and Class 3 (middle-aged onset) incurred the highest cost during the year of CKD onset, with those in Class 1 having more comorbidities than those in Class 3 at baseline. Multiple healthcare services contributed to the high healthcare costs in Class 1, with costs in Class 3 attributed mainly to post-CKD outpatient and psychiatric care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\/interpretation<\/jats:title>\n                    <jats:p>Those with young-onset type 2 diabetes incurred the highest cost during the year of CKD onset. Individuals with middle-aged onset type 2 diabetes with fewer comorbidities and less intensified treatment at baseline\u00a0also had subsequent increased healthcare costs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00125-026-06698-2","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T12:12:03Z","timestamp":1773835923000},"page":"1792-1805","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Differential healthcare costs in individuals with type 2 diabetes and incident chronic kidney disease in Hong Kong: a latent class trajectory analysis"],"prefix":"10.1007","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0515-7272","authenticated-orcid":false,"given":"Yanrong","family":"Du","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3026-357X","authenticated-orcid":false,"given":"Minglu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8589-8522","authenticated-orcid":false,"given":"Abby Q. Y.","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1581-5643","authenticated-orcid":false,"given":"Eric S. H.","family":"Lau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2193-1114","authenticated-orcid":false,"given":"Hongjiang","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8927-6764","authenticated-orcid":false,"given":"Alice P. S.","family":"Kong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5244-6069","authenticated-orcid":false,"given":"Andrea O. Y.","family":"Luk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1227-803X","authenticated-orcid":false,"given":"Ronald C. W.","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3904-8056","authenticated-orcid":false,"given":"Chun-Kwan","family":"O","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6214-6924","authenticated-orcid":false,"given":"Lee-Ling","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9383-7448","authenticated-orcid":false,"given":"Jenny Y. Z.","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8846-7515","authenticated-orcid":false,"given":"Wai Kit","family":"Ming","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5158-2245","authenticated-orcid":false,"given":"Weijian","family":"Ke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3782-9210","authenticated-orcid":false,"given":"Yanbing","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1325-1194","authenticated-orcid":false,"given":"Juliana C. N.","family":"Chan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4034-1286","authenticated-orcid":false,"given":"Juliana N. M.","family":"Lui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"issue":"1","key":"6698_CR1","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1038\/s41572-024-00589-9","volume":"11","author":"P Romagnani","year":"2025","unstructured":"Romagnani P, Agarwal R, Chan JCN et al (2025) Chronic kidney disease. Nat Rev Dis Primers 11(1):8. https:\/\/doi.org\/10.1038\/s41572-024-00589-9","journal-title":"Nat Rev Dis Primers"},{"issue":"5","key":"6698_CR2","doi-asserted-by":"publisher","first-page":"963","DOI":"10.2337\/dc17-1962","volume":"41","author":"C Bommer","year":"2018","unstructured":"Bommer C, Sagalova V, Heesemann E et al (2018) Global economic burden of diabetes in adults: projections from 2015 to 2030. Diabetes Care 41(5):963\u2013970. https:\/\/doi.org\/10.2337\/dc17-1962","journal-title":"Diabetes Care"},{"key":"6698_CR3","unstructured":"Centers for Disease Control and Prevention (2023) Chronic Kidney Disease in the United States, 2023. Available from https:\/\/www.cdc.gov\/kidney-disease\/media\/pdfs\/CKD-Factsheet-H.pdf. Accessed 11 Nov 2024"},{"issue":"20","key":"6698_CR4","doi-asserted-by":"publisher","first-page":"2129","DOI":"10.1001\/jama.2009.726","volume":"301","author":"JCN Chan","year":"2009","unstructured":"Chan JCN, Malik V, Jia WP et al (2009) Diabetes in Asia epidemiology, risk factors, and pathophysiology. JAMA 301(20):2129\u20132140. https:\/\/doi.org\/10.1001\/jama.2009.726","journal-title":"JAMA"},{"issue":"11","key":"6698_CR5","doi-asserted-by":"publisher","first-page":"2057","DOI":"10.1038\/sj.ki.5000377","volume":"69","author":"HH Parving","year":"2006","unstructured":"Parving HH, Lewis JB, Ravid M, Remuzzi G, Hunsicker LG, DEMAND investigators (2006) Prevalence and risk factors for microalbuminuria in a referred cohort of type II diabetic patients: a global perspective. Kidney Int 69(11):2057\u20132063. https:\/\/doi.org\/10.1038\/sj.ki.5000377","journal-title":"Kidney Int"},{"issue":"1","key":"6698_CR6","doi-asserted-by":"publisher","first-page":"80","DOI":"10.18553\/jmcp.2023.29.1.80","volume":"29","author":"HC Chung","year":"2023","unstructured":"Chung HC, Crowe CL, Kong SX et al (2023) Descriptive study of the economic burden among patients with type 2 diabetes mellitus, chronic kidney disease, and chronic kidney disease and type 2 diabetes mellitus in a large US commercially insured population. J Manag Care Spec Pham 29(1):80\u201389. https:\/\/doi.org\/10.18553\/jmcp.2023.29.1.80","journal-title":"J Manag Care Spec Pham"},{"issue":"10","key":"6698_CR7","doi-asserted-by":"publisher","first-page":"4405","DOI":"10.1007\/s12325-023-02608-9","volume":"40","author":"V Jha","year":"2023","unstructured":"Jha V, Al-Ghamdi SMG, Li GS et al (2023) Global economic burden associated with chronic kidney disease: a pragmatic review of medical costs for the inside CKD research programme. Adv Ther 40(10):4405\u20134420. https:\/\/doi.org\/10.1007\/s12325-023-02608-9","journal-title":"Adv Ther"},{"issue":"11","key":"6698_CR8","doi-asserted-by":"publisher","first-page":"100532","DOI":"10.1016\/j.xkme.2022.100532","volume":"4","author":"CD Mullins","year":"2022","unstructured":"Mullins CD, Pantalone KM, Betts KA et al (2022) CKD progression and economic burden in individuals with CKD associated with type 2 diabetes. Kidney Med 4(11):100532. https:\/\/doi.org\/10.1016\/j.xkme.2022.100532","journal-title":"Kidney Med"},{"key":"6698_CR9","doi-asserted-by":"publisher","first-page":"111961","DOI":"10.1016\/j.diabres.2024.111961","volume":"219","author":"JNM Lui","year":"2025","unstructured":"Lui JNM, Lau ESH, Li AQY et al (2025) Temporal incremental healthcare costs associated with complications in Hong Kong Chinese patients with type 2 diabetes: A prospective study in Joint Asia diabetes evaluation (JADE) Register (2007\u20132019). Diabetes Res Clin Pract 219:111961. https:\/\/doi.org\/10.1016\/j.diabres.2024.111961","journal-title":"Diabetes Res Clin Pract"},{"issue":"12","key":"6698_CR10","doi-asserted-by":"publisher","first-page":"3075","DOI":"10.2337\/dci22-0027","volume":"45","author":"IH de Boer","year":"2022","unstructured":"de Boer IH, Khunti K, Sadusky T et al (2022) Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO). Diabetes Care 45(12):3075\u20133090. https:\/\/doi.org\/10.2337\/dci22-0027","journal-title":"Diabetes Care"},{"issue":"4","key":"6698_CR11","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1001\/jamainternmed.2022.6817","volume":"183","author":"L Wang","year":"2023","unstructured":"Wang L, Xu X, Zhang M et al (2023) Prevalence of chronic kidney disease in China: results from the sixth China chronic disease and risk factor surveillance. JAMA Int Med 183(4):298\u2013310. https:\/\/doi.org\/10.1001\/jamainternmed.2022.6817","journal-title":"JAMA Int Med"},{"issue":"6","key":"6698_CR12","doi-asserted-by":"publisher","first-page":"e13503","DOI":"10.1111\/1753-0407.13503","volume":"16","author":"JNM Lui","year":"2024","unstructured":"Lui JNM, Lau ESH, Yang AM et al (2024) Temporal associations of diabetes-related complications with health-related quality of life decrements in Chinese patients with type 2 diabetes: a prospective study among 19 322 adults-Joint Asia Diabetes Evaluation (JADE) register (2007\u20132018). J Diabetes 16(6):e13503. https:\/\/doi.org\/10.1111\/1753-0407.13503","journal-title":"J Diabetes"},{"issue":"10267","key":"6698_CR13","doi-asserted-by":"publisher","first-page":"2019","DOI":"10.1016\/S0140-6736(20)32374-6","volume":"396","author":"JCN Chan","year":"2021","unstructured":"Chan JCN, Lim LL, Wareham NJ et al (2021) The lancet commission on diabetes: using data to transform diabetes care and patient lives. Lancet 396(10267):2019\u20132082. https:\/\/doi.org\/10.1016\/S0140-6736(20)32374-6","journal-title":"Lancet"},{"issue":"11","key":"6698_CR14","doi-asserted-by":"publisher","first-page":"2022","DOI":"10.2337\/dci19-0003","volume":"42","author":"JCN Chan","year":"2019","unstructured":"Chan JCN, Lim LL, Luk AOY et al (2019) From Hong Kong diabetes register to JADE program to RAMP-DM for data-driven actions. Diabetes Care 42(11):2022\u20132031. https:\/\/doi.org\/10.2337\/dci19-0003","journal-title":"Diabetes Care"},{"key":"6698_CR15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v042.i10","volume":"42","author":"DA Linzer","year":"2011","unstructured":"Linzer DA, Lewis JB (2011) poLCA: an R package for polytomous variable latent class analysis. J Stat Softw 42:1\u201329. https:\/\/doi.org\/10.18637\/jss.v042.i10","journal-title":"J Stat Softw"},{"issue":"4","key":"6698_CR16","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1093\/pan\/mpq025","volume":"18","author":"JK Vermunt","year":"2010","unstructured":"Vermunt JK (2010) Latent class modeling with covariates: two improved three-step approaches. Political Analysis 18(4):450\u2013469. https:\/\/doi.org\/10.1093\/pan\/mpq025","journal-title":"Political Analysis"},{"issue":"1","key":"6698_CR17","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1111\/cdep.12163","volume":"10","author":"ST Lanza","year":"2016","unstructured":"Lanza ST, Cooper BR (2016) Latent class analysis for developmental research. Child Dev Perspect 10(1):59\u201364. https:\/\/doi.org\/10.1111\/cdep.12163","journal-title":"Child Dev Perspect"},{"issue":"2","key":"6698_CR18","doi-asserted-by":"publisher","first-page":"378","DOI":"10.32614\/Rj-2017-066","volume":"9","author":"ME Brooks","year":"2017","unstructured":"Brooks ME, Kristensen K, van Benthem KJ et al (2017) glmmTMB balances speed and flexibility among packages for zero-inflated generalized linear mixed modeling. R J 9(2):378\u2013400. https:\/\/doi.org\/10.32614\/Rj-2017-066","journal-title":"R J"},{"key":"6698_CR19","doi-asserted-by":"publisher","unstructured":"Chang HY, Kharrazi H, Bodycombe D, Weiner JP, Alexander GC (2018) Healthcare costs and utilization associated with high-risk prescription opioid use: a retrospective cohort study. BMC Med 16(1):69. https:\/\/doi.org\/10.1186\/S12916-018-1058-y","DOI":"10.1186\/S12916-018-1058-y"},{"issue":"4","key":"6698_CR20","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1093\/biomet\/88.4.987","volume":"88","author":"Y Lee","year":"2001","unstructured":"Lee Y, Nelder JA (2001) Hierarchical generalised linear models: a synthesis of generalised linear models, random-effect models and structured dispersions. Biometrika 88(4):987\u20131006. https:\/\/doi.org\/10.1093\/biomet\/88.4.987","journal-title":"Biometrika"},{"issue":"2","key":"6698_CR21","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1002\/wics.201","volume":"4","author":"MJ Gurka","year":"2012","unstructured":"Gurka MJ, Kelley GA, Edwards LJ (2012) Fixed and random effects models. Wiley Interdiscip Rev Comput Stat 4(2):181\u2013190. https:\/\/doi.org\/10.1002\/wics.201","journal-title":"Wiley Interdiscip Rev Comput Stat"},{"issue":"2","key":"6698_CR22","doi-asserted-by":"publisher","first-page":"30","DOI":"10.3978\/j.issn.2305-5839.2015.12.63","volume":"4","author":"ZH Zhang","year":"2016","unstructured":"Zhang ZH (2016) Multiple imputation with multivariate imputation by chained equation (MICE) package. Ann Transl Med 4(2):30. https:\/\/doi.org\/10.3978\/j.issn.2305-5839.2015.12.63","journal-title":"Ann Transl Med"},{"issue":"6","key":"6698_CR23","doi-asserted-by":"publisher","first-page":"1544","DOI":"10.2337\/dc13-1928","volume":"37","author":"RR Rubin","year":"2014","unstructured":"Rubin RR, Wadden TA, Bahnson JL et al (2014) Impact of intensive lifestyle intervention on depression and health-related quality of life in type 2 diabetes: the Look AHEAD Trial. Diabetes Care 37(6):1544\u20131553. https:\/\/doi.org\/10.2337\/dc13-1928","journal-title":"Diabetes Care"},{"key":"6698_CR24","doi-asserted-by":"publisher","unstructured":"Yang AM, Wu HJ, Lau ESH et al (2022) Glucose-lowering drug use, glycemic outcomes, and severe hypoglycemia: 18-Year trends in 0.9 million adults with Diabetes in Hong Kong (2002\u20132019). Lancet Reg Health WP 26:100509. https:\/\/doi.org\/10.1016\/j.lanwpc.2022.100509","DOI":"10.1016\/j.lanwpc.2022.100509"},{"issue":"12","key":"6698_CR25","doi-asserted-by":"publisher","first-page":"2032","DOI":"10.2215\/Cjn.11491116","volume":"12","author":"RZ Alicic","year":"2017","unstructured":"Alicic RZ, Rooney MT, Tuttle KR (2017) Diabetic kidney disease challenges, progress, and possibilities. Clin J Am Soc Nephro 12(12):2032\u20132045. https:\/\/doi.org\/10.2215\/Cjn.11491116","journal-title":"Clin J Am Soc Nephro"},{"issue":"1","key":"6698_CR26","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/S2213-8587(17)30186-9","volume":"6","author":"N Lascar","year":"2018","unstructured":"Lascar N, Brown J, Pattison H, Barnett AH, Bailey CJ, Bellary S (2018) Type 2 diabetes in adolescents and young adults. Lancet Diabetes Endocrinol 6(1):69\u201380. https:\/\/doi.org\/10.1016\/S2213-8587(17)30186-9","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"12","key":"6698_CR27","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1016\/s2213-8587(24)00242-0","volume":"12","author":"B Lin","year":"2024","unstructured":"Lin B, Coleman RL, Bragg F, Maddaloni E, Holman RR, Adler AI (2024) Younger-onset compared with later-onset type 2 diabetes: an analysis of the UK Prospective Diabetes Study (UKPDS) with up to 30 years of follow-up (UKPDS 92). Lancet Diabetes Endocrinol 12(12):904\u2013914. https:\/\/doi.org\/10.1016\/s2213-8587(24)00242-0","journal-title":"Lancet Diabetes Endocrinol"},{"key":"6698_CR28","doi-asserted-by":"publisher","first-page":"110954","DOI":"10.1016\/j.diabres.2023.110954","volume":"205","author":"YN Fan","year":"2023","unstructured":"Fan YN, Fan BQ, Lau ESH et al (2023) Comparison of beta-cell function between Hong Kong Chinese with young-onset type 2 diabetes and late-onset type 2 diabetes. Diabetes Res Clin Pract 205:110954. https:\/\/doi.org\/10.1016\/j.diabres.2023.110954","journal-title":"Diabetes Res Clin Pract"},{"issue":"3","key":"6698_CR29","doi-asserted-by":"publisher","first-page":"e004120","DOI":"10.1136\/bmjdrc-2024-004120","volume":"12","author":"O Ck","year":"2024","unstructured":"O CK, Fan YN, Fan B et al (2024) Precision Medicine to Redefine Insulin Secretion and Monogenic Diabetes-Randomized Controlled Trial (PRISM-RCT) in Chinese patients with young-onset diabetes: design, methods and baseline characteristics. BMJ Open Diabetes Res Care 12(3):e004120. https:\/\/doi.org\/10.1136\/bmjdrc-2024-004120","journal-title":"BMJ Open Diabetes Res Care"},{"issue":"3","key":"6698_CR30","doi-asserted-by":"publisher","first-page":"145","DOI":"10.7326\/M18-1900","volume":"170","author":"C Ke","year":"2019","unstructured":"Ke C, Lau E, Shah BR et al (2019) Excess burden of mental illness and hospitalization in young-onset type 2 diabetes: a population-based cohort study. Ann Intern Med 170(3):145\u2013154. https:\/\/doi.org\/10.7326\/M18-1900","journal-title":"Ann Intern Med"},{"issue":"5 Suppl Guideli","key":"6698_CR31","doi-asserted-by":"publisher","first-page":"S265","DOI":"10.1046\/j.1532-5415.51.5s.1.x","volume":"51","author":"AF Brown","year":"2003","unstructured":"Brown AF, Mangione CM, Saliba D, Sarkisian CA, California Healthcare Foundation\/American Geriatrics Society Panel on Improving Care for Elders with Diabetes (2003) Guidelines for improving the care of the older person with diabetes mellitus. J Am Geriatr Soc 51(5 Suppl Guidelines):S265-280. https:\/\/doi.org\/10.1046\/j.1532-5415.51.5s.1.x","journal-title":"J Am Geriatr Soc"},{"issue":"5","key":"6698_CR32","doi-asserted-by":"publisher","first-page":"747","DOI":"10.2337\/diacare.21.5.747","volume":"21","author":"JS Krop","year":"1998","unstructured":"Krop JS, Powe NR, Weller WE, Shaffer TJ, Saudek CD, Anderson GF (1998) Patterns of expenditures and use of services among older adults with diabetes - Implications for the transition to capitated managed care. Diabetes Care 21(5):747\u2013752. https:\/\/doi.org\/10.2337\/diacare.21.5.747","journal-title":"Diabetes Care"},{"issue":"6","key":"6698_CR33","doi-asserted-by":"publisher","first-page":"421","DOI":"10.7326\/0003-4819-141-6-200409210-00007","volume":"141","author":"E Selvin","year":"2004","unstructured":"Selvin E, Marinopoulos S, Berkenblit G et al (2004) Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med 141(6):421\u2013431. https:\/\/doi.org\/10.7326\/0003-4819-141-6-200409210-00007","journal-title":"Ann Intern Med"},{"issue":"9","key":"6698_CR34","doi-asserted-by":"publisher","first-page":"1306","DOI":"10.1111\/jdi.14228","volume":"15","author":"JCN Chan","year":"2024","unstructured":"Chan JCN, Mbanya JC, Chantelot JM et al (2024) Patient-reported outcomes and treatment adherence in type 2 diabetes using natural language processing: Wave 8 of the Observational International Diabetes Management Practices Study. J Diabetes Investig 15(9):1306\u20131316. https:\/\/doi.org\/10.1111\/jdi.14228","journal-title":"J Diabetes Investig"},{"issue":"10448","key":"6698_CR35","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1016\/S0140-6736(24)00537-3","volume":"404","author":"AI Adler","year":"2024","unstructured":"Adler AI, Coleman RL, Leal J, Whiteley WN, Clarke P, Holman RR (2024) Post-trial monitoring of a randomised controlled trial of intensive glycaemic control in type 2 diabetes extended from 10 years to 24 years (UKPDS 91). Lancet 404(10448):145\u2013155. https:\/\/doi.org\/10.1016\/S0140-6736(24)00537-3","journal-title":"Lancet"},{"issue":"16","key":"6698_CR36","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.2217\/cer-2022-0110","volume":"11","author":"F Tsotra","year":"2022","unstructured":"Tsotra F, Kappel M, Peristeris P et al (2022) The societal impact of early intensified treatment in patients with type 2 diabetes mellitus. J Comp Effect Res 11(16):1185\u20131199. https:\/\/doi.org\/10.2217\/cer-2022-0110","journal-title":"J Comp Effect Res"},{"issue":"1","key":"6698_CR37","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1113\/Jp277002","volume":"597","author":"S Koszegi","year":"2019","unstructured":"Koszegi S, Molnar A, Lenart L et al (2019) RAAS inhibitors directly reduce diabetes-induced renal fibrosis via growth factor inhibition. J Physiol 597(1):193\u2013209. https:\/\/doi.org\/10.1113\/Jp277002","journal-title":"J Physiol"},{"issue":"21","key":"6698_CR38","doi-asserted-by":"publisher","first-page":"E729","DOI":"10.1503\/cmaj.230093","volume":"195","author":"SY Zhou","year":"2023","unstructured":"Zhou SY, Su LC, Xu RQ et al (2023) Statin initiation and risk of incident kidney disease in patients with diabetes. Can Med Assoc J 195(21):E729\u2013E738. https:\/\/doi.org\/10.1503\/cmaj.230093","journal-title":"Can Med Assoc J"},{"issue":"3","key":"6698_CR39","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1007\/s00125-024-06309-y","volume":"68","author":"GC Yu","year":"2025","unstructured":"Yu GC, Tam CHT, Lim CKP et al (2025) Type 2 diabetes pathway-specific polygenic risk scores elucidate heterogeneity in clinical presentation, disease progression and diabetic complications in 18,217 Chinese individuals with type 2 diabetes. Diabetologia 68(3):602\u2013614. https:\/\/doi.org\/10.1007\/s00125-024-06309-y","journal-title":"Diabetologia"},{"issue":"2","key":"6698_CR40","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1007\/s00125-024-06320-3","volume":"68","author":"O Chun-Kwan","year":"2025","unstructured":"Chun-Kwan O, Fan BQ, Tsoi STF et al (2025) A polygenic risk score derived from common variants of monogenic diabetes genes is associated with young-onset type 2 diabetes and cardiovascular-kidney complications. Diabetologia 68(2):367\u2013381. https:\/\/doi.org\/10.1007\/s00125-024-06320-3","journal-title":"Diabetologia"},{"issue":"Supplement_1","key":"6698_CR41","doi-asserted-by":"publisher","first-page":"S195","DOI":"10.2337\/dc22-S013","volume":"45","author":"American Diabetes Association Professional Practice Committee","year":"2022","unstructured":"American Diabetes Association Professional Practice Committee (2022) 13. Older adults: standards of medical care in diabetes\u20142022. Diabetes Care 45(Supplement_1):S195\u2013S207. https:\/\/doi.org\/10.2337\/dc22-S013","journal-title":"Diabetes Care"},{"issue":"1","key":"6698_CR42","doi-asserted-by":"publisher","first-page":"e3711","DOI":"10.1002\/dmrr.3711","volume":"40","author":"JTK Cheung","year":"2024","unstructured":"Cheung JTK, Yang A, Wu H et al (2024) Early treatment with dipeptidyl-peptidase 4 inhibitors reduces glycaemic variability and delays insulin initiation in type 2 diabetes: A propensity score-matched cohort study. Diabetes Metab Res Rev 40(1):e3711. https:\/\/doi.org\/10.1002\/dmrr.3711","journal-title":"Diabetes Metab Res Rev"},{"issue":"8","key":"6698_CR43","doi-asserted-by":"publisher","first-page":"3339","DOI":"10.1111\/dom.15662","volume":"26","author":"JT Cheung","year":"2024","unstructured":"Cheung JT, Yang A, Wu H et al (2024) Association of dipeptidyl peptidase\u20104 inhibitor initiation at glycated haemoglobin <7.5% with reduced major clinical events mediated by low glycated haemoglobin variability. Diabetes Obes Metab 26(8):3339\u20133351. https:\/\/doi.org\/10.1111\/dom.15662","journal-title":"Diabetes Obes Metab"},{"issue":"8","key":"6698_CR44","doi-asserted-by":"publisher","first-page":"e1004261","DOI":"10.1371\/journal.pmed.1004261","volume":"20","author":"HJ Wu","year":"2023","unstructured":"Wu HJ, Yang AM, Lau ESH et al (2023) Age- and sex-specific hospital bed-day rates in people with and without type 2 diabetes: A territory-wide population-based cohort study of 1.5 million people in Hong Kong. Plos Med 20(8):e1004261. https:\/\/doi.org\/10.1371\/journal.pmed.1004261","journal-title":"Plos Med"},{"issue":"3","key":"6698_CR45","doi-asserted-by":"publisher","first-page":"464","DOI":"10.2337\/diacare.25.3.464","volume":"25","author":"LE Egede","year":"2002","unstructured":"Egede LE, Zheng D, Simpson K (2002) Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care 25(3):464\u2013470. https:\/\/doi.org\/10.2337\/diacare.25.3.464","journal-title":"Diabetes Care"},{"issue":"10","key":"6698_CR46","doi-asserted-by":"publisher","first-page":"1822","DOI":"10.1007\/s00125-008-1113-x","volume":"51","author":"JS Gonzalez","year":"2008","unstructured":"Gonzalez JS, Delahanty LM, Safren SA, Meigs JB, Grant RW (2008) Differentiating symptoms of depression from diabetes-specific distress: relationships with self-care in type 2 diabetes. Diabetologia 51(10):1822\u20131825. https:\/\/doi.org\/10.1007\/s00125-008-1113-x","journal-title":"Diabetologia"},{"issue":"1","key":"6698_CR47","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.numecd.2013.04.010","volume":"24","author":"S Balducci","year":"2014","unstructured":"Balducci S, Sacchetti M, Orlando G et al (2014) Correlates of muscle strength in diabetes: the study on the assessment of determinants of muscle and bone strength abnormalities in diabetes (SAMBA). Nutr Metab Cardiovasc Dis 24(1):18\u201326. https:\/\/doi.org\/10.1016\/j.numecd.2013.04.010","journal-title":"Nutr Metab Cardiovasc Dis"},{"issue":"1","key":"6698_CR48","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/0738-3991(92)90102-O","volume":"19","author":"RE Glasgow","year":"1992","unstructured":"Glasgow RE, Toobert DJ, Hampson SE, Brown JE, Lewinsohn PM, Donnelly J (1992) Improving self-care among older patients with type II diabetes: the \u201cSixty Something...\u201d Study. Patient Educ Couns 19(1):61\u201374. https:\/\/doi.org\/10.1016\/0738-3991(92)90102-O","journal-title":"Patient Educ Couns"},{"key":"6698_CR49","doi-asserted-by":"publisher","first-page":"3061","DOI":"10.12659\/Msm.913512","volume":"25","author":"L Dong","year":"2019","unstructured":"Dong L, Li J, Lian Y et al (2019) Long-term intensive lifestyle intervention promotes improvement of stage III diabetic nephropathy. Med Sci Monitor 25:3061\u20133068. https:\/\/doi.org\/10.12659\/Msm.913512","journal-title":"Med Sci Monitor"},{"issue":"3","key":"6698_CR50","doi-asserted-by":"publisher","first-page":"520","DOI":"10.2337\/db21-0694","volume":"71","author":"GZ Jiang","year":"2022","unstructured":"Jiang GZ, Luk AO, Tam CHT et al (2022) Clinical predictors and long-term impact of acute kidney injury on progression of diabetic kidney disease in Chinese patients with type 2 diabetes. Diabetes 71(3):520\u2013529. https:\/\/doi.org\/10.2337\/db21-0694","journal-title":"Diabetes"}],"container-title":["Diabetologia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00125-026-06698-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00125-026-06698-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00125-026-06698-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T14:41:22Z","timestamp":1780584082000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00125-026-06698-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,18]]},"references-count":50,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["6698"],"URL":"https:\/\/doi.org\/10.1007\/s00125-026-06698-2","relation":{},"ISSN":["0012-186X","1432-0428"],"issn-type":[{"value":"0012-186X","type":"print"},{"value":"1432-0428","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,18]]},"assertion":[{"value":"19 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"We express our gratitude to all participants of the HKDR, collaborating doctors, nurses and healthcare assistants for their contribution in establishing this 12-year cohort. An abstract from this study was presented at the International Diabetes Federation World Diabetes Congress of 2025 in Bangkok, Thailand, on 7\u201310 April 2025.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Acknowledgements"}},{"value":"The participant-level data used and\/or analysed during the current study are not available, since consent was not been obtained for data sharing. Summary data may be available from the corresponding author on reasonable request.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data availability"}},{"value":"A general research fund (reference no. 14121723) supported by the Research Grant Committee was awarded to JNML. The study sponsor\/funder was not involved in the design of the study, in the collection, analysis and interpretation of data or in writing the report, and did not impose any restrictions regarding the publication of the report.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"APSK has received research grants and\/or speaker honoraria from Abbott, Astra Zeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Kyowa Kirin, Merck Serono, Nestle, Novo Nordisk, Pfizer and Sanofi. AOYL reported receiving grants and\/or honoraria for consultancy or giving lectures from Amgen, AstraZeneca, Boehringer Ingelheim, Merck Sharp & Dohme, Novartis, Novo Nordisk and Sanofi. RCWM reported receiving grants and\/or honoraria for consultancy or giving lectures from AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Pfizer and Takeda and is a member of the editorial board of\n                      Diabetologia\n                      . L-LL reported receiving grants and\/or honoraria for consultancy or giving lectures from AstraZeneca, Abbott, Boehringer Ingelheim, GSK, Novartis, Novo Nordisk, Viatris and Zuellig Pharma. JCNC has received research grants through her affiliated institutions and\/or honoraria for consultancy or giving lectures from Applied Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Celltrion, Eli Lilly, Hua Medicine, Merck, Merck Sharp & Dohme, Novo Nordisk, Novartis, Pfizer, Servier, Sanofi and Viatris. JNML has received a research grant from Roche Diagnostics Hong Kong Limited for a project unrelated to this manuscript. All other authors declare that there are no relationships or activities that might bias, or be perceived to bias, their contribution to this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 relationships and activities"}},{"value":"YD, MZ, AQYL, JCNC and JNML contributed to the concept and design. YD, MZ, JCNC and JNML conducted the analysis and drafted the manuscript. ESHL is the data manager of the HKDR and contributed to data curation and data cleaning. All authors contributed to data collection, interpretation of results and revision of the manuscript and approved the final version for submission. JCNC and JNML are the guarantors.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Contribution statement"}},{"value":"The study adhered to the Declaration of Helsinki, and written informed consent was obtained from all participants. The study was approved by the Clinical Research Ethics Committees of The Chinese University of Hong Kong (reference no. 2009.421).","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}]}}