Risk Groups for Type 2 Diabetes can also be Identified at an Older Age
A recent study furnishes evidence that in people without diabetes, six risk groups for cardiometabolic complications previously identified in middle-aged people can also be identified in older people. In cooperation with Helmholtz Munich, the researchers at the German Diabetes Center (DDZ) also showed that there is a special risk group characterized by the combination of a high inflammatory load, a measure of silent inflammatory processes, and a high risk of type 2 diabetes and complications.
As part of the prospective population study KORA F4/FF4 (Cooperative Health Research in the Augsburg Region), 843 people aged 61 to 82 without type 2 diabetes were classified into six risk groups that are called clusters. The clusters were initially described by Prof. Dr. Robert Wagner, Head of the Clinical Study Center of the Institute of Clinical Diabetology and Deputy Director of the Clinic for Endocrinology and Diabetology at the University Hospital of Düsseldorf (UKD), and employees and differ in terms of the risk of developing type 2 diabetes and (pre-)diabetes-related complications such as chronic kidney disease, nerve damage and cardiovascular disease.
Risk of type 2 diabetes and complications varies depending on the cluster
Cluster 2 (“very low risk”) showed the lowest risk of cardiovascular disease and the lowest inflammation levels, while cluster 5 (“high risk with insulin-resistant fatty liver”) showed the highest inflammation levels as well as a high disease burden. The frequency of new cases (incidence) of type 2 diabetes was significantly higher in clusters 3, 4, 5 and 6 than in cluster 2.
An inflammation index, what is called the inflammatory load, was derived on the basis of 73 inflammation markers. This load was significantly increased in cluster 5 in particular, indicating extensive inflammatory processes as a possible driver of metabolic derailments.
“The results illustrate the importance of early differentiation of risk groups – even at an advanced age,” emphasizes Prof. Dr. Christian Herder, Deputy Director and Head of the Inflammation Working Group of the Institute of Clinical Diabetology at the DDZ. Prof. Dr. Michael Roden, Scientific Managing Director and Spokesman of the Board of the DDZ and Director of the Clinic for Endocrinology and Diabetology at the UKD, explains: “This study underlines the individual differences in the risk of diabetes and diabetes-related diseases and thus edges the way to more precise early detection and prevention, even at an older age.”
Original publication:
Huemer MT, Spagnuolo MC, Maalmi H, Wagner R, Bönhof GJ, Heier M, Koenig W, Rathmann W, Prystupa K, Nano J, Ziegler D, Peters A, Roden M, Thorand B, Herder C. 2025. Phenotype-based clusters, inflammation and cardiometabolic complications in older people before the diagnosis of type 2 diabetes: KORA F4/FF4 cohort study. Cardiovasc Diabetol. 24(1):83.
https://doi.org/10.1186/s12933-025-02617-8
The German Diabetes Center (DDZ) serves as the German reference center for diabetes. Its objective is to contribute to the improvement of prevention, early detection, diagnosis and treatment of diabetes mellitus. At the same time, the research center aims at improving the epidemiological data situation in Germany. The DDZ coordinates the multicenter German Diabetes Study and is a point of contact for all players in the health sector. In addition, it prepares scientific information on diabetes mellitus and makes it available to the public. The DDZ is part of the Leibniz Association (Wissenschaftsgemeinschaft Gottfried Wilhelm Leibniz, WGL) and is a partner of the German Center for Diabetes Research (DZD e.V.). www.ddz.de/en
The German Center for Diabetes Research (DZD) is a national association that brings together experts in the field of diabetes research and combines basic research, translational research, epidemiology and clinical applications. The aim is to develop novel strategies for personalized prevention and treatment of diabetes. Members are Helmholtz Munich – German Research Center for Environmental Health, the German Diabetes Center in Düsseldorf, the German Institute of Human Nutrition in Potsdam-Rehbrücke, the Paul Langerhans Institute Dresden of Helmholtz Munich at the University Medical Center Carl Gustav Carus of the TU Dresden and the Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich at the Eberhard-Karls-University of Tuebingen together with associated partners at the Universities in Heidelberg, Cologne, Leipzig, Lübeck and Munich. www.dzd-ev.de/en
