CONTEXT The components of metabolic syndrome (MetS) are interrelated and associated with renal complications in patients with type 2 diabetes (T2D). AIMS We aimed to reveal prevalent metabolic profiles in patients with T2D and identify which metabolic profiles were risk markers for renal progression. METHODS A total of 3556 participants with T2D from a hospital (derivation cohort) and 931 participants with T2D from a community survey (external validation cohort) were included. The primary outcome was the onset of diabetic kidney disease (DKD), and secondary outcomes included eGFR decline, macroalbuminuria, and end-stage renal disease (ESRD). In the derivation cohort, clusters were identified using the five components of MetS, and their relationships with the outcomes were assessed. To validate the findings, participants in the validation cohort were assigned to clusters. Multivariate odds ratios (ORs) of the primary outcome were evaluated in both cohorts, adjusted for multiple covariates at baseline. RESULTS In the derivation cohort, six clusters were identified as metabolic profiles. Compared with cluster 1, cluster 3 (severe hyperglycemia) had increased risks of DKD (HR [95% CI]: 1.72 [1.39-2.12]), macroalbuminuria (2.74 [1.84-4.08]), ESRD (4.31 [1.16-15.99]), and eGFR decline [P < 0.001]; cluster 4 (moderate dyslipidemia) had increased risks of DKD (1.97 [1.53-2.54]) and macroalbuminuria (2.62 [1.61-4.25]). In the validation cohort, clusters 3 and 4 were replicated to have significantly increased risks of DKD (adjusted ORs: 1.24 [1.07-1.44] and 1.39 [1.03-1.87]). CONCLUSIONS We identified six prevalent metabolic profiles in patients with T2D. Severe hyperglycemia and moderate dyslipidemia were validated as significant risk markers for DKD.

中文翻译：

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2 型糖尿病的代谢特征及其与肾脏并发症的关系。

背景 代谢综合征 (MetS) 的各个组成部分相互关联，并与 2 型糖尿病 (T2D) 患者的肾脏并发症相关。目的 我们的目的是揭示 T2D 患者普遍的代谢特征，并确定哪些代谢特征是肾脏进展的风险标志物。方法 总共纳入了 3556 名来自医院的 T2D 参与者（派生队列）和 931 名来自社区调查的 T2D 参与者（外部验证队列）。主要结局是糖尿病肾病（DKD）的发病，次要结局包括 eGFR 下降、大量白蛋白尿和终末期肾病（ESRD）。在推导队列中，使用 MetS 的五个组成部分来识别聚类，并评估它们与结果的关系。为了验证研究结果，验证队列中的参与者被分配到集群中。对两个队列的主要结局的多变量比值比（OR）进行了评估，并在基线时针对多个协变量进行了调整。结果 在推导队列中，六个簇被确定为代谢谱。与组 1 相比，组 3（严重高血糖）发生 DKD（HR [95% CI]：1.72 [1.39-2.12]）、大量白蛋白尿（2.74 [1.84-4.08]）、ESRD（4.31 [1.16-15.99]）的风险增加) 和 eGFR 下降 [P < 0.001]；第 4 组（中度血脂异常）患 DKD（1.97 [1.53-2.54]）和大量白蛋白尿（2.62 [1.61-4.25]）的风险增加。在验证队列中，集群 3 和集群 4 的 DKD 风险显着增加（调整后的 OR：1.24 [1.07-1.44] 和 1.39 [1.03-1.87]）。结论 我们确定了 2 型糖尿病患者的六种常见代谢特征。重度高血糖和中度血脂异常被证实为 DKD 的重要风险标志物。