Evidence map›Paper›PMID 37798471›Full record

ArticleCommunications medicine2023

Precision subclassification of type 2 diabetes: a systematic review.

Shivani Misra, Robert Wagner, Bige Ozkan, Martin Schön, Magdalena Sevilla-Gonzalez, Katsiaryna Prystupa, Caroline C Wang, Raymond J Kreienkamp, Sara J Cromer, Mary R Rooney and 18 more

Registry-linked trialAbstract read
In one paragraph

Article in Communications medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07461805 (Caracterización de Subgrupos de Personas Con Diabetes Tipo 1), which is not on this map. Cited by 65 papers.

0numbers the graph read from it
0cells of the map it votes in
65citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07461805 recruitingnot on this mapstarted 2025, after this paper: background citation

Caracterización de Subgrupos de Personas Con Diabetes Tipo 1: análisis de características clínicas y glucométricas Utilizando Una aproximación de Inteligencia Artificial

Typeobservational_patient_registrySponsorFundació Institut de Recerca de l'Hospital de la Santa Creu i Sant PauRan2025 to 2028Enrolled800ConditionsType 1 Diabetes Mellitus
3 · Its place in the literature

Who cites it

65 citing papers in PubMed.

  1. Trial
  2. Trial
  3. Review
  4. Review
  5. Review
  6. Article
  7. From language matters to stigma-free communication in diabetes: Evolution, challenges, and next steps.Diabetic medicine : a journal of the British Diabetic Association · 2026
    Review
  8. Review
  9. Article
  10. Article
  11. Genetic basis of Asian diabetes.Journal of diabetes investigation · 2026
    Review
  12. Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Metabolic dysfunction and the use of adjunct medications in type 1 diabetes.Current opinion in endocrinology, diabetes, and obesity · 2026
    Review
  18. Article
  19. Article
  20. Review

5 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

28 authors.

Shivani Misra *Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK. s.misra@imperial.ac.uk.ORCID http://orcid.org/0000-0003-2886-0726
Robert Wagner *Department of Endocrinology and Diabetology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.ORCID http://orcid.org/0000-0002-6120-0191
Bige OzkanWelch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.ORCID http://orcid.org/0000-0003-2745-1189
Martin SchönInstitute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.ORCID http://orcid.org/0000-0002-9224-4189
Magdalena Sevilla-GonzalezClinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA.ORCID http://orcid.org/0000-0001-6135-9998
Katsiaryna PrystupaInstitute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.ORCID http://orcid.org/0000-0003-3368-1028
Caroline C WangWelch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Raymond J KreienkampPrograms in Metabolism and Medical & Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.ORCID http://orcid.org/0000-0002-1683-323X
Sara J CromerPrograms in Metabolism and Medical & Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.
Mary R RooneyWelch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.ORCID http://orcid.org/0000-0002-5607-4848
Daisy DuanDivision of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA.ORCID http://orcid.org/0000-0002-4392-3206
Anne Cathrine Baun ThuesenNovo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.ORCID http://orcid.org/0000-0002-8639-9117
Amelia S WallaceWelch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.ORCID http://orcid.org/0000-0002-1466-3791
Aaron LeongPrograms in Metabolism and Medical & Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.
Aaron J DeutschPrograms in Metabolism and Medical & Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.ORCID http://orcid.org/0000-0001-6750-5335
Mette K AndersenNovo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.ORCID http://orcid.org/0000-0001-8227-1469
Liana K BillingsDivision of Endocrinology, Diabetes and Metabolism, NorthShore University Health System, Skokie, IL, USA.ORCID http://orcid.org/0000-0001-7991-3010
Robert H EckelDivision of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA.
Wayne Huey-Herng SheuInstitute of Molecular and Genomic Medicine, National Health Research Institute, Miaoli County, Taiwan, ROC.
Torben HansenNovo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.ORCID http://orcid.org/0000-0001-8748-3831
Norbert StefanGerman Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.ORCID http://orcid.org/0000-0002-2186-9595
Mark O GoodarziDivision of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.ORCID http://orcid.org/0000-0001-6364-5103
Debashree RayDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.ORCID http://orcid.org/0000-0002-0979-2935
Elizabeth SelvinWelch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.ORCID http://orcid.org/0000-0001-6923-7151
Jose C FlorezPrograms in Metabolism and Medical & Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.
ADA/EASD PMDI
James B MeigsPrograms in Metabolism and Medical & Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.
Miriam S UdlerPrograms in Metabolism and Medical & Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.ORCID http://orcid.org/0000-0003-3824-9162

Funding

Transgenic & Knock-out MouseP30DK063491 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI ALAN R. SALTIEL · 2003 to 2026
$40.4M
TRAINING PROGRAM IN ENDOCRINOLOGY AND DIABETEST32DK007028 · NIDDK · MASSACHUSETTS GENERAL HOSPITAL · PI Karen K Miller · 1986 to 2026
$18.5M
CARDIOVASCULAR EPIDEMIOLOGY INSTITUTIONAL TRAININGT32HL007024 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI Elizabeth Selvin · 1985 to 2026
$17.5M
TOPMed Omics of Type 2 Diabetes and Quantitative TraitsUM1DK078616 · NIDDK · MASSACHUSETTS GENERAL HOSPITAL · PI MANNING, ALISA KNODLE · 2021 to 2025
$3.8M
Rare Sequence Variation and Diabetes Quantitative TraitsU01DK078616 · NIDDK · MASSACHUSETTS GENERAL HOSPITAL · PI MEIGS, JAMES B · 2015 to 2019
$3.6M
TOPMed Omics of Cardiovascular Disease in DiabetesR01HL151855 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI MEIGS, JAMES B · 2020 to 2023
$3.3M
Metabolic Effects of Circadian-Based Dinner TimeK23DK133690 · NIDDK · JOHNS HOPKINS UNIVERSITY · PI Daisy Duan · 2022 to 2026
$1.0M
Clinical Implications of Genetically Defined Diabetes Subtypes and Application to Electronic Health Medical Record SystemsK23DK114551 · NIDDK · MASSACHUSETTS GENERAL HOSPITAL · PI UDLER, MIRIAM SARGON · 2017 to 2021
$1000k
Mentoring Investigators on the Clinical Translation of Cardiometabolic Genetic DiscoveriesK24HL157960 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI FLOREZ, JOSE CARLOS · 2021 to 2025
$626k
Research and Mentoring in the Clinical Epidemiology of Cardiovascular Disease and Type 2 DiabetesK24HL152440 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI SELVIN, ELIZABETH · 2020 to 2024
$612k
Multi-trait genome-wide characterization of non-traditional glycemic biomarkers and type 2 diabetesR21DK125888 · NIDDK · JOHNS HOPKINS UNIVERSITY · PI RAY, DEBASHREE · 2021 to 2022
$450k
British Heart Foundation RG/17/12/33167Medical Research Council MC_UU_00014/4NHLBI NIH HHS K24 HL152440NHLBI NIH HHS K24 HL157960NHLBI NIH HHS R01 HL151855NHLBI NIH HHS T32 HL007024NIDDK NIH HHS K23 DK114551NIDDK NIH HHS K23 DK133690NIDDK NIH HHS P30 DK063491NIDDK NIH HHS R21 DK125888NIDDK NIH HHS T32 DK007028NIDDK NIH HHS U01 DK078616NIDDK NIH HHS UM1 DK078616Wellcome Trust 210752/Z/18/Z
6 · The paper itself

Abstract

backgroundHeterogeneity in type 2 diabetes presentation and progression suggests that precision medicine interventions could improve clinical outcomes. We undertook a systematic review to determine whether strategies to subclassify type 2 diabetes were associated with high quality evidence, reproducible results and improved outcomes for patients.

methodsWe searched PubMed and Embase for publications that used 'simple subclassification' approaches using simple categorisation of clinical characteristics, or 'complex subclassification' approaches which used machine learning or 'omics approaches in people with established type 2 diabetes. We excluded other diabetes subtypes and those predicting incident type 2 diabetes. We assessed quality, reproducibility and clinical relevance of extracted full-text articles and qualitatively synthesised a summary of subclassification approaches.

resultsHere we show data from 51 studies that demonstrate many simple stratification approaches, but none have been replicated and many are not associated with meaningful clinical outcomes. Complex stratification was reviewed in 62 studies and produced reproducible subtypes of type 2 diabetes that are associated with outcomes. Both approaches require a higher grade of evidence but support the premise that type 2 diabetes can be subclassified into clinically meaningful subtypes.

conclusionCritical next steps toward clinical implementation are to test whether subtypes exist in more diverse ancestries and whether tailoring interventions to subtypes will improve outcomes.

Identifiers

PMID37798471
PMCPMC10556101

What Socratic holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.