Relevance of Dietary Patterns for Diabetes-Related Comorbidities in Subgroups of Individuals with Recent-Onset Diabetes

糖尿病分为1型糖尿病（T1D）和2型糖尿病（T2D）一直受到质疑，并提出了基于聚类分析的5个亚组。这些亚组在临床特征和糖尿病相关并发症的风险方面存在差异。对于T1D和T2D患者，越来越多的证据表明，早期病程可能对长期疾病进展产生深远影响，在糖尿病诊断后的头几年，通过靶向饮食等方式实现良好的代谢控制，可能会减少并发症的发生。虽然有证据表明单一饮食模式对葡萄糖代谢的影响，以及在较小程度上对糖尿病的心脏代谢危险因素的影响，但大多数饮食模式的证据很少，研究结果也不确定，特别是饮食模式与微血管并发症的关系。此外，所有的研究都是使用传统的糖尿病分类进行的，在代谢更均匀的亚组中，这些亚组的并发症风险不同，尚未研究。基于我们之前的工作(i)调查饮食因素对代谢控制的影响和（ii）在T1D和T2D早期过程中糖尿病相关并发症的决定因素，我们现在计划在德国糖尿病研究（GDS）中测试以下研究问题，分为5个糖尿病亚组，在糖尿病诊断后的第一年以及之后的5年内：(1)在GDS的两个检查时间点，5个糖尿病亚组之间基于假设和探索性的饮食模式是否存在差异？(横截面)。(2) 5个亚组之间基于假设和探索性饮食模式的差异是否可以通过聚类变量或糖代谢的进一步参数来解释？(横截面)。(3)在GDS的两个检查时间点，假设型和探索性饮食模式是否也与心血管代谢危险因素和糖尿病相关微血管并发症的中间表型相关？(横截面)。(4)基于假设和探索性的饮食模式与心血管代谢危险因素和糖尿病相关微血管并发症的中间表型之间的关联在糖尿病亚组之间是否存在差异？(横截面)。(5)基线饮食模式与5年糖代谢参数、心血管代谢危险因素和糖尿病相关微血管并发症中间表型的变化在糖尿病亚组之间是否存在差异？(纵向)。我们相信，该项目将有助于提高对糖尿病诊断后早期饮食及其与代谢、心血管和微血管特征的关系的理解，从而将朝着开发针对糖尿病相关并发症的有针对性的营养预防策略迈出进一步的一步。

The classification of diabetes into type 1 (T1D) and type 2 diabetes (T2D) has been questioned and a sub-classification into 5 subgroups based on cluster analysis has been proposed. These subgroups differ in their clinical characteristics and risk of diabetes-related complications. For people with T1D and T2D, increasing evidence suggests that the early disease course might have a profound impact on long-term disease progression and that good metabolic control during the first years after diabetes diagnosis, achieved by targeting e.g. diet, may reduce the development of complications. Although evidence exists for the impact of single dietary patterns on glucose metabolism and, to a lesser extent, for cardiometabolic risk factors in diabetes, evidence for the majority of dietary patterns is scarce and findings are inconclusive, specifically for associations of dietary patterns with microvascular complications. Also, all research has been conducted using the traditional diabetes classification and effects in metabolically more homogenous subgroups, who differ in their risk of complications, has not been studied yet. Based on our previous work (i) investigating the impact of dietary factors for metabolic control and (ii) on determinants of diabetes-related complications during the early time course of T1D and T2D, we now plan to test the following research questions within German Diabetes Study (GDS), classified into the 5 diabetes subgroups, within the first year after diabetes diagnosis as well as 5 years thereafter: (1) Are there differences in hypothesis-based and explorative dietary patterns between the 5 diabetes subgroups at the two examination time points of the GDS? (cross-sectional). (2) Are the differences in hypothesis-based and explorative dietary patterns between the 5 subgroups explained by clustering variables or further parameters of glucose metabolism? (cross-sectional). (3) Are hypothesis-based and explorative dietary patterns also related to cardiometabolic risk factors and intermediate phenotypes of diabetes-related microvascular complications at the two examination time points of the GDS? (cross-sectional). (4) Do associations of hypothesis-based and explorative dietary patterns with cardiometabolic risk factors and intermediate phenotypes of diabetes-related microvascular complications differ between diabetes subgroups? (cross-sectional). (5) Do associations of dietary patterns at baseline with 5-year changes of parameters of glucose metabolism, cardiometabolic risk factors and intermediate phenotypes of diabetes-related microvascular complications differ between diabetes subgroups? (longitudinal). We believe that this project will contribute to an improved understanding of diet and its association with metabolic, cardiovascular and microvascular traits early after diabetes diagnosis and will thus be a further step towards the development of targeted nutritional prevention strategies for diabetes-related complications.