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Population stratification in type 2 diabetes mellitus: A systematic review

Population stratification in type 2 diabetes mellitus: A systematic review
Population stratification in type 2 diabetes mellitus: A systematic review
Aims: There is increasing interest in using stratification in type 2 diabetes to target resources, individualise care and improve outcomes. We aim to systematically review and collate literature that has utilised population stratification methods in the study of adults with type 2 diabetes; and to describe and compare stratification methodologies, population characteristics, variables used to stratify and outcome variables.

Methods: The MEDLINE, EMBASE, CINAHL and Cochrane databases were searched from inception to July 2020. Studies included adults with type 2 diabetes using population stratification methods. The review protocol was registered on PROSPERO (ID: CRD42020206604) and conducted in line with PRISMA guidance. Extracted data included study aims; study setting (primary or secondary care); population characteristics; stratification variables and outcomes; and methodological approach to stratification.

Results: Across 348 included studies, there were a total of 10,776,009 participants with a mean age of 61.0 years (SD 5.94). 6.7% of studies used data-driven methods and the rest employed expert-driven approaches using pre-defined stratification criteria. The commonest variable used to stratify populations was HbA1c (n = 57, 16.4%); few studies stratified using clinically important non-traditional variables such as health behaviours and beliefs.

Conclusions: Most studies performing population stratification in type 2 diabetes used expert-driven approaches with the aim of predicting outcomes in glycaemic control, mortality and cardiovascular complications. We identified relatively few studies using data-driven approaches, which offer opportunities generate hypotheses beyond current expert knowledge. We describe important research gaps including stratification with regard to disease remission.
clustering, methodology, stratification, systematic review, type 2 diabetes
0742-3071
e14688
Hodgson, Sam
6e051dfd-5283-4720-8c53-1fae01b34339
Cheema, Sukhmani
e83d9149-007e-42e0-bb89-2ce42e19c259
Rani, Zareena
27550ce0-cfef-4217-9005-fb579e3b0f8d
Olaniyan, Doyinsola
c414cfd6-3482-414a-a6f1-b9627d9faadd
O'Leary, Ellen
2d26ee13-33b8-44d8-becc-a10b2388afb6
Price, Hermione
7452f07d-82ab-4c46-99d2-429b7373278b
Dambha-Miller, Hajira
58961db5-31aa-460e-9394-08590c4b7ba1
Hodgson, Sam
6e051dfd-5283-4720-8c53-1fae01b34339
Cheema, Sukhmani
e83d9149-007e-42e0-bb89-2ce42e19c259
Rani, Zareena
27550ce0-cfef-4217-9005-fb579e3b0f8d
Olaniyan, Doyinsola
c414cfd6-3482-414a-a6f1-b9627d9faadd
O'Leary, Ellen
2d26ee13-33b8-44d8-becc-a10b2388afb6
Price, Hermione
7452f07d-82ab-4c46-99d2-429b7373278b
Dambha-Miller, Hajira
58961db5-31aa-460e-9394-08590c4b7ba1

Hodgson, Sam, Cheema, Sukhmani, Rani, Zareena, Olaniyan, Doyinsola, O'Leary, Ellen, Price, Hermione and Dambha-Miller, Hajira (2022) Population stratification in type 2 diabetes mellitus: A systematic review. Diabetic medicine : a journal of the British Diabetic Association, 39 (1), e14688, [e14688]. (doi:10.1111/dme.14688).

Record type: Review

Abstract

Aims: There is increasing interest in using stratification in type 2 diabetes to target resources, individualise care and improve outcomes. We aim to systematically review and collate literature that has utilised population stratification methods in the study of adults with type 2 diabetes; and to describe and compare stratification methodologies, population characteristics, variables used to stratify and outcome variables.

Methods: The MEDLINE, EMBASE, CINAHL and Cochrane databases were searched from inception to July 2020. Studies included adults with type 2 diabetes using population stratification methods. The review protocol was registered on PROSPERO (ID: CRD42020206604) and conducted in line with PRISMA guidance. Extracted data included study aims; study setting (primary or secondary care); population characteristics; stratification variables and outcomes; and methodological approach to stratification.

Results: Across 348 included studies, there were a total of 10,776,009 participants with a mean age of 61.0 years (SD 5.94). 6.7% of studies used data-driven methods and the rest employed expert-driven approaches using pre-defined stratification criteria. The commonest variable used to stratify populations was HbA1c (n = 57, 16.4%); few studies stratified using clinically important non-traditional variables such as health behaviours and beliefs.

Conclusions: Most studies performing population stratification in type 2 diabetes used expert-driven approaches with the aim of predicting outcomes in glycaemic control, mortality and cardiovascular complications. We identified relatively few studies using data-driven approaches, which offer opportunities generate hypotheses beyond current expert knowledge. We describe important research gaps including stratification with regard to disease remission.

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More information

Accepted/In Press date: 11 September 2021
e-pub ahead of print date: 14 September 2021
Published date: January 2022
Additional Information: Funding Information: The Royal College of General Practitioners? Scientific Foundation Board supported this research through a Practitioner Access Grant awarded to SH (RCGP-SFB-2020-25). The Primary Care Research Centre at the University of Southampton is a member of the NIHR School for Primary Care Research and supported by NIHR Research funds. ZR was in receipt of an NIHR School for Primary Care Research (SPCR) student grant. SH is an NIHR Academic Clinical Fellow. HDM is an NIHR Clinical Lecturer. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the SPCR or the Department of Health and Social Care. We acknowledge and thank the patients and members of the public who kindly shared their time, lived experience and personal expertise with the research team. Funding Information: The Royal College of General Practitioners’ Scientific Foundation Board supported this research through a Practitioner Access Grant awarded to SH (RCGP‐SFB‐2020‐25). The Primary Care Research Centre at the University of Southampton is a member of the NIHR School for Primary Care Research and supported by NIHR Research funds. ZR was in receipt of an NIHR School for Primary Care Research (SPCR) student grant. SH is an NIHR Academic Clinical Fellow. HDM is an NIHR Clinical Lecturer. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the SPCR or the Department of Health and Social Care. Publisher Copyright: © 2021 Diabetes UK Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: clustering, methodology, stratification, systematic review, type 2 diabetes

Identifiers

Local EPrints ID: 453019
URI: http://eprints.soton.ac.uk/id/eprint/453019
ISSN: 0742-3071
PURE UUID: 9bf2b41c-e311-4250-9bdc-284c3d6bc79c
ORCID for Hajira Dambha-Miller: ORCID iD orcid.org/0000-0003-0175-443X

Catalogue record

Date deposited: 07 Jan 2022 17:05
Last modified: 12 Apr 2022 01:55

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Contributors

Author: Sam Hodgson
Author: Sukhmani Cheema
Author: Zareena Rani
Author: Doyinsola Olaniyan
Author: Ellen O'Leary
Author: Hermione Price

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