Trial reportJournal of diabetes investigation2026
Data-driven cluster analysis of adults with prediabetes: Findings from the Japan diabetes prevention study.
Trial report in Journal of diabetes investigation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
6 authors.
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Abstract
aimTo identify distinct metabolic subtypes among Japanese adults with prediabetes and examine their association with type 2 diabetes (T2D) risk and response to lifestyle interventions.
methodsData from 295 adults with impaired glucose tolerance (mean age 50.4 ± 14.6 years) enrolled in the Japanese Diabetes Prevention Program, a randomized controlled trial with up to 6 years of follow-up, were analyzed. Participants with a history of diabetes, gastrectomy, or exercise contraindications were excluded from the study. K-means clustering (k = 2-5) was applied to baseline indices, including HbA1c, HOMA-β, HOMA-IR, and HDL-cholesterol. Principal component analysis (PCA) was used for interpretation. Incident T2D was defined as a repeat 75-g OGTT. Kaplan-Meier and Cox models were adjusted for baseline HbA1c estimated cumulative incidence and hazard ratios (HRs).
resultsThree clusters emerged at k = 3, and PCA (two components explaining 68.0% of the variance) clearly separated the clusters based on insulin resistance and glycemic indices. Cluster 1, Metabolically Resilient Prediabetes (n = 127, MRP), showed the most favorable metabolic profile and lowest T2D risk. Cluster 2, Insulin-Insufficient Prediabetes (n = 109, IIP), exhibited reduced β-cell function and the highest T2D risk, but derived the greatest benefit from lifestyle intervention (adjusted HR 0.40, 95% CI 0.17-0.95, P < 0.05). Cluster 3, Severe Insulin-Resistant Prediabetes (SIRP; n = 59), displayed obesity-related insulin resistance and an intermediate risk.
conclusionsUnsupervised clustering identified three biologically distinct prediabetic subtypes that differed in diabetes risk and intervention responsiveness, supporting a precision prevention framework for Japanese adults with prediabetes.
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