Subgroups of patients with young-onset type 2 diabetes in India reveal insulin deficiency as a major driver
Diabetes is a heterogeneous disease. The five distinct subgroups proposed are (SAID); (SIDD);(SIRD); (MOD); (MARD). The subgroups vary in their clinical characteristics and pathophysiological mechanisms and susceptibility to complication. Therefore, early identification of subclasses may be vital for appropriate treatment to reduce adverse outcomes
Indian individuals develop T2DM at a younger age and are thinner. Indians also differ in body composition, having higher fat and lower lean proportions at the same BMI. T2DM in Indians is primarily driven by insulin resistance. Lean type 2 diabetes is prevalent in India, especially in undernourished regions. Rashmi B. Prasad and colleagues conducted study titled “Subgroups of patients with young-onset type 2 diabetes in India reveal insulin deficiency as a major driver” published in Diabetologia.
Objective:
To test the applicability of phenotyping in Indian individuals with young-onset type 2 diabetes.
Methods:
Data pooled from WellGen cohort applied de novo k-means clustering to the WellGen cohort to validate the subgroups. Followed by comparing clinical and metabolic-endocrine characteristics and the complication rates between the subgroups. Characteristics of the WellGen subgroups with those of two young European cohorts, ANDIS and DIREVA were compared. Subgroups were also assessed in two other Indian cohorts, Ahmedabad and PHENOEINDY-2. Genome-wide genotyping data was generated on WellGen and PMNS participants using Affymetrix SNP 6.0 Chips and the Infinium Global Screening Array V1 B37.
Findings:
SIDD and MOD were the two predominant subgroups, while MARD was less common and SIRD the least common in both, European and Indian . SIDD was the predominant cluster in Indians whereas MOD was the most prevalent in Europeans. Nephropathy and retinopathy were more prevalent in SIDD compared to that of MODWe showed that the clusters described in the newly diagnosed unselected European type 2 diabetes patients [2, 3] are also seen in the younger and thinner Indians. SIDD and MOD were the two predominant subgroups, while MARD was less common and SIRD the least common in both populations. SIDD was the predominant cluster in Indians whereas MOD was the most prevalent in Europeans the later had high prevalence of neuropathy.
Limitations:
The Indian patients are clinic-based and enrolled many years after diabetes diagnosis while on glucose-lowering treatment, which may affect the proportions of subclasses. Another limitation is that this study is an opportunistic comparison of existing data and therefore laboratory measurements are not fully harmonised between cohorts.
Image Credit : Background vector created by freepik – www.freepik.com
