{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T19:38:30Z","timestamp":1793907510070,"version":"4.8.0"},"reference-count":51,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T00:00:00Z","timestamp":1749427200000},"content-version":"unspecified","delay-in-days":39,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Faculty of Medicine Siriraj Hospital","award":["R016233029"],"award-info":[{"award-number":["R016233029"]}]},{"name":"MU","award":["R016620001"],"award-info":[{"award-number":["R016620001"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"accepted":{"date-parts":[[2025,3,31]]},"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Pre-diabetes comprises diverse subphenotypes linked to varying complications, type 2 diabetes, and mortality outcomes. This study aimed to explore these outcomes across different pre-diabetes subphenotypes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Research design and methods<\/jats:title>\n                  <jats:p>The dataset included adults without type 2 diabetes with baseline HbA1c and fasting plasma glucose (FPG) measurements from Siriraj Hospital, Bangkok, Thailand. The participants were classified into six subphenotypes via the <jats:italic>k<\/jats:italic>-means clustering method on the basis of age, body mass index, FPG, HbA1c, high-density lipoprotein cholesterol and alanine aminotransferase levels. The incidences of type 2 diabetes, long-term vascular complications and mortality were compared among subphenotypes over a median follow-up of 8.8 years, employing Kaplan-Meier curves and Cox regression analysis adjusted for sex, statin use and hypertension status.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among the 4915 participants (mean age 60.1\u00b110.1 years; 54.6% female), six clusters emerged: cluster 1, low risk (n=650; 13.2%); cluster 2, mild dysglycemia elderly (n=791; 16.1%); cluster 3, severe dysglycemia obese (n=1127; 22.9%); cluster 4, mild dysglycemia obese (n=963; 19.7%); cluster 5, severe dysmetabolic obese (n=337; 6.9%); and cluster 6, severe dysglycemia elderly (n=1042; 21.2%). Clusters were classified into diabetes risk subgroups: low risk (clusters 1 and 4) and high risk (clusters 3 and 5). Cluster 6 exhibited the highest risk, with significantly increased incidences of macrovascular complications (adjusted HR 2.22, 1.51\u20133.27) and type 2 diabetes (1.73, 1.42\u20132.12). In contrast, cluster 4 demonstrated the lowest risk, with significantly decreased incidences of new chronic kidney disease (0.65, 0.44\u20130.96), microvascular complications (0.62, 0.43\u20130.89) and mortality (0.25, 0.10\u20130.63).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our pre-diabetes phenotyping approach effectively provides valuable insights into the risk of type 2 diabetes, vascular complications and mortality in individuals with pre-diabetes. Those with high-risk phenotypes should be prioritized for type 2 diabetes and cardiovascular interventions to mitigate risks.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjdrc-2024-004803","type":"journal-article","created":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T14:30:19Z","timestamp":1749479419000},"page":"e004803","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Identification of pre-diabetes subphenotypes for type 2 diabetes, related vascular complications and mortality"],"prefix":"10.1136","volume":"13","author":[{"given":"Chaiwat","family":"Washirasaksiri","sequence":"first","affiliation":[{"name":"Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nutsakol","family":"Borrisut","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine Siriraj 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