Diabetes Phenotypes in Patients Presenting a Myocardial Infarction: Progress Towards Precision Medicine?

Abstract

Background/Objectives: Despite advances in personalized medicine, diabetes classification and management have remained widely unchanged for decades. The aims of the present study were to determine profiles of patients with type 2 diabetes at the time of their myocardial infarction and to assess 1-year cardiovascular events. Methods: All type 2 diabetic patients admitted for myocardial infarction in our Coronary Intensive Care Unit between 1 April 2021 and 30 June 2023 were included in this retrospective study. To identify patient profiles, we performed a data-driven cluster analysis based on the k-means method according to six characteristics considered as the most relevant in the literature (age at diabetes diagnosis, body mass index, glycated hemoglobin, glutamate decarboxylase antibodies, insulin resistance and beta-cell function). Cox multivariate models were used to identify predictors of 1-year cardiovascular event- and major adverse cardiovascular event-free survivals. Results: This study included 250 patients with a median age of 71 years. Our cluster repartition was as follows: 46% patients presented a severe insulin-deficient diabetes, 3% a severe insulin-resistant diabetes, 16% a mild obesity-related diabetes, 33% a mild age-related diabetes, and 2% patients suffered from a severe autoimmune diabetes. In multivariate analyses, the only independent factor for both longer cardiovascular event- and major adverse cardiovascular event-free survival was a higher glomerular function rate (hazard ratio of 0.97 and 0.98 per 1 mL/mn/1.73 m²; p = 0.01 and p = 0.03, respectively). Conclusions: This study suggests that the severe insulin-deficient diabetes and mild age-related diabetes pathophysiological phenotypes, easily estimated using insulin resistance and beta-cell function as well as age at diabetes diagnosis, body mass index, and glycated hemoglobin, were more frequent among diabetic patients at the time of their myocardial infarction. In daily clinical practice, caution is needed for patients with a low glomerular function rate, as this was associated with shorter cardiovascular event- and major adverse cardiovascular event-free survival at 1-year.