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World J Diabetes. Nov 15, 2026; 17(11): 122820
Published online Nov 15, 2026. doi: 10.4239/wjd.122820
Published online Nov 15, 2026. doi: 10.4239/wjd.122820
Cluster-based metabolic subphenotypes and projected cross-organ risk in Chinese adults with prediabetes
Shu-Han Zhang, Li-Ping Yu, Jin-Ping Zhang, Lu-Lu Song, Li-Li Wu, Zhao-Qing Li, Yi-Fan He, Rui-Fen Deng, Wan-Lu Ma, Cong Zhang, Xian Jin, Bo Zhang, Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, China
Shu-Han Zhang, Department of Endocrinology and Metabolism, Peking University Health Science Center, Beijing 100191, China
Co-first authors: Shu-Han Zhang and Li-Ping Yu.
Author contributions: Zhang SH and Yu LP were responsible for conceptualization, writing original draft, writing review and editing as co-first authors; Yu LP, Zhang JP, Song LL, Wu LL, Li ZQ, He YF, Deng RF, Ma WL, Zhang C, and Jin X were responsible for data collection, writing – review and editing; Zhang B was responsible for writing review and editing, the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis; all the authors approved the final version of the manuscript.
AI contribution statement: The authors take full responsibility and accountability for all content of this manuscript, including any portions for which AI tools were used as assistive technologies. All AI-assisted outputs were carefully reviewed, validated, and approved by the authors. AI tools were not used to generate original scientific data, perform independent scientific analyses, or draw scientific conclusions.
Supported by National High-Level Hospital Clinical Research Funding, No. 2025-NHLHCRF-JBGS-B-WZ-01; and National Key Research and Development Program of China, No. 2018YFC1313902.
Institutional review board statement: The study program was reviewed and approved by the Clinical Research Ethics Committee of China-Japan Friendship Hospital (No. 2019-63-k43).
Clinical trial registration statement: This study has been registered at https://clinicaltrials.gov/study/NCT03987438 (ID: NCT03987438).
Informed consent statement: All participants provided informed consent.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The datasets generated during and/or analyzed in the current study are available from the corresponding author upon reasonable request.
Corresponding author: Bo Zhang, MD, Professor, Department of Endocrinology, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing 100029, China. zhangbo@zryhyy.com.cn
Received: April 29, 2026
Revised: July 4, 2026
Accepted: October 8, 2026
Published online: November 15, 2026
Processing time: 190 Days and 5.7 Hours
Revised: July 4, 2026
Accepted: October 8, 2026
Published online: November 15, 2026
Processing time: 190 Days and 5.7 Hours
Core Tip
Core Tip: Prediabetes is not a uniform metabolic state. In this Chinese multicenter cohort, cluster-defined subphenotypes showed distinct projected cardio–kidney–liver risk-score patterns. Mild age-related dysmetabolism represented a broad, age-loaded projected-risk subtype across Framingham, chronic kidney disease prognosis consortium, and fibrosis-4 domains. Severe insulin deficiency showed the most unexpected signal: Despite lower adiposity and lack of a classical insulin-resistant phenotype, it remained enriched for projected chronic kidney disease risk and fibrosis-4-defined liver fibrosis-risk signal. These findings connect prediabetes subphenotyping with an integrated organ-risk framework and support prospective validation of subtype-informed risk assessment before overt diabetes.