# Differential risk of cardiovascular complications in patients with type-2 diabetes mellitus in Ghana: A hospital-based cross-sectional study

## TL;DR

This study identifies distinct subgroups of type-2 diabetes patients in Ghana with varying risks of cardiovascular disease based on obesity and insulin resistance.

## Contribution

The study reveals gender-specific subgroups of T2DM patients with differing cardiovascular risks based on adiposity and insulin resistance.

## Key findings

- Female patients with severe insulin resistance had a significantly higher risk of cardiovascular disease and metabolic syndrome.
- Male patients with obesity and severe insulin resistance showed increased intermediate and high-risk CVD.
- The study highlights cardiometabolic heterogeneity among T2DM patients in Ghana.

## Abstract

To characterize clinically relevant subgroups of patients with type-2 diabetes mellitus (T2DM) based on adiposity, insulin secretion, and resistance indices.

A cross-sectional study was conducted at Eastern Regional Hospital in Ghana from July to October 2021 to investigate long-term patients with T2DM. To select participants, a systematic random sampling method was employed. Demographic data was collected using a structured questionnaire and fasting blood samples were taken to measure glycemic and lipid levels. Blood pressure and adiposity indices were measured during recruitment. The risk of cardiovascular disease (CVD) was defined using Framingham scores and standard low-density lipoprotein thresholds. To analyze the data, k-means clustering algorithms and regression analysis were used.

The study identified three groups in female patients according to body mass index, relative fat mass, glycated hemoglobin, and triglyceride-glucose index. These groups included the obesity-related phenotype, the severe insulin resistance phenotype, and the normal weight phenotype with improved insulin resistance. Among male patients with T2DM, two groups were identified, including the obesity-related phenotype with severe insulin resistance and the normal weight phenotype with improved insulin sensitivity. The severe insulin resistance phenotype in female patients was associated with an increased risk of high CVD (OR = 5.34, 95%CI:2.11–13.55) and metabolic syndrome (OR = 7.07; 95%CI:3.24–15.42). Among male patients, the obesity-related phenotype with severe insulin resistance was associated with an increased intermediate (OR = 21.78, 95%CI:4.17–113.78) and a high-risk CVD (OR = 6.84, 95%CI:1.45–32.12).

The findings highlight significant cardiometabolic heterogeneity among T2DM patients. The subgroups of T2DM patients characterized by obesity and/or severe insulin resistance with or without poor glycemic control, have increased risk of CVD. This underscores the importance of considering differences in adiposity, insulin secretion, and sensitivity indices when making clinical decisions for patients with T2DM.