Multi-Comorbidity Clustering in Type 2 Diabetes: Simultaneous Bone, Neural, and Metabolic Complications Predict High-Risk Phenotypes

Introduction and Objective: Diabetes complications often occur together rather than in isolation. This study aimed to identify multi-comorbidity patterns involving bone, neural, and metabolic complications in Type 2 Diabetes patients in resource-limited community settings to improve risk stratification. Methods: Cross-sectional study of ~400 T2DM patients was conducted using data from screening camps with bone density (DEXA), neuropathy grading, hepatoscan and metabolic profile. Four complications were defined: low bone density, peripheral neuropathy, dyslipidemia and hepatic steatosis. Patients were grouped by number of complications (0 to ≥4) and associations with clinical and metabolic parameters was analyzed. Results: Overall, 82% had atleast 1 complication: 31% had only one complication, 28% had two, 15% had three, and 8% had four simultaneously. Reduced bone density was most common (76%), followed by dyslipidemia (68%) and neuropathy (52%). Common combinations were bone density loss plus dyslipidemia (24%) and neuropathy plus dyslipidemia (18%). Patients with ≥2 complications had higher triglycerides and BMI but similar HbA1c levels. 44% of well-controlled patients (HbA1c<7%) still had ≥2 complications, suggesting glycemia-independent mechanisms. Conclusion: Multi-comorbidity clustering affects over 80% of T2DM patients. Half exhibit two or more simultaneous complications. Complication clustering correlates strongly with triglycerides and BMI but weakly with HbA1c, indicating that metabolic factors beyond glucose drive multi-comorbidity burden. Nearly half of well-controlled patients harbor multiple complications, challenging glucose-centric screening paradigms. This approach enables precision risk stratification and comprehensive multi-system complication screening at diabetes diagnosis. Disclosure: R. Viegas: None. S. Patil: None. A. Maheshwari: None. A. Raha: None. S. Singla: None.