1644-P: Novel Subgroups of Prediabetes and Their Clinical Outcomes: A Data-Driven Analysis

The progression of prediabetes to diabetes and the reversion of them to NGT are highly heterogeneous. To develop a refined classification of prediabetes, we used data-driven K-means clustering in patients diagnosed with IGT and IFG according to WHO 1999 criteria in Pinggu Study (a prospective population-based survey for diabetes in suburban Beijing, n=628), NHANES III study (a cross-sectional population-based survey in the U.S., n=1532) and Beijing Prediabetes Reversion Program (BPRP, a RCT to evaluate the efficacy of lifestyle and/or pioglitazone on prediabetes reversion, n=1905). Based on five variables including HbA1c, BMI, age, HOMAIR and HOMAB, we identified four replicable clusters across all three datasets including high glucose group (HGG), lean group (LG), early-onset group (EOG) and insulin resistant group (IRG) (Figure). HRG had significant higher 1-year diabetes progression rate (15.4% in BPRP and 25.6% in Pinggu study) and the LG had the lowest diabetes progression rate (7.1% in BPRP and 11.1% in Pinggu Study). In BPRP, HGG treated with Intensive lifestyle plus pioglitazone had significant higher reversion rate to NGT and EOG treated with intensive life style plus placebo had least reversion rate compared to other treatment. Our study provides risk stratification for prediabetes and can potentially facilitate clinical decision, representing a first step towards precision management.