Subtypes of newly diagnosed type 2 diabetes and risk of complications: analysis of electronic health records in the USA
Authors' conclusion
Individuals with different type 2 diabetes subtypes, identified through electronic health records, differ in terms of their risk of vascular complications. These findings support leveraging routine electronic health record data to improve the characterisation of patient heterogeneity at the time of diabetes diagnosis.
Study context
- Population
- Adults (≥18 years) with newly diagnosed T2D, Epic Cosmos data across all 50 US states and DC, 2012–2023; mean age 64.4 years (SD 13.3), 52% female
- Participants
- 727,076 adults
- Exposure
- T2D subtypes vs MOD
- Outcome
- Rates of microvascular (retinopathy, neuropathy, nephropathy) and macrovascular complications (severe ASCVD, other ASCVD, HF)
Methodological detailselectronic health records, Epic Cosmos research platform, Cox proportional hazards regression adjusted for age and sex
- Electronic health records
- Epic Cosmos research platform
- Cox proportional hazards regression adjusted for age and sex
Main finding
As reported in the abstract
Vascular complications, SIDD vs MOD
SIDD vs MODHazard ratio (95% CI)
Retinopathy
2.83(2.73–2.93)
Neuropathy
1.57(1.54–1.60)
Nephropathy
1.34(1.32–1.37)
Severe ASCVD
1.49(1.46–1.53)
Other ASCVD
1.23(1.21–1.25)
HF
1.17(1.15–1.20)
Observational data: associations, not effects.
Further findings
Subtype distribution · at diagnosis
Prevalence of severe insulin-deficient diabetes (SIDD) and MOD by race/ethnicity
- Hispanics: SIDD, MOD
- 28.4% and 30.1%
- Non-Hispanic Black: SIDD, MOD
- 25.5% and 30.0%
- Non-Hispanic White: SIDD, MOD
- 20.1% and 21.6%
- SIDD more prevalent in DC and MOD in Utah vs rest of country
Original publication
Subtypes of newly diagnosed type 2 diabetes and risk of complications: analysis of electronic health records in the USA. Diabetologia. Published 21 February 2026. doi:10.
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