Subgroups of young type 2 diabetes in India reveal insulin deficiency as a major driver
| Autor: | Sanjeeb Kakati, Rashmi B. Prasad, Emma Ahlqvist, Banshi Saboo, Annemari Käräjämäki, Parikh M, Dattatrey Bhat, Pooja Kunte, Chittaranjan S. Yajnik, Leif Groop, Tiinamaija Tuomi, Rucha H. Wagh, Anupam Datta, Olof Asplund, Sanjeev Phatak, Shukla, Meet Shah |
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| Rok vydání: | 2021 |
| Předmět: |
2. Zero hunger
medicine.medical_specialty business.industry 030209 endocrinology & metabolism Type 2 diabetes 030204 cardiovascular system & hematology medicine.disease Obesity 3. Good health Nephropathy 03 medical and health sciences 0302 clinical medicine Insulin resistance Internal medicine Diabetes mellitus Cohort medicine Complication business Retinopathy |
| Popis: | Aim/HypothesisFive subgroups were described in European diabetes patients using a data driven machine learning approach on commonly measured variables. We aimed to test the applicability of this phenotyping in Indian young-onset type 2 diabetes patients.MethodsWe applied the European derived centroids to the Indian type 2 diabetes patients diagnosed before 45 years of age from the WellGen (n = 1612) cohort. We also applied de novo k-means clustering to the WellGen cohort to validate the subgroups. We then compared clinical and metabolic-endocrine characteristics and the complication rates between the subgroups. We also compared characteristics of the WellGen subgroups with those of two young European cohorts ANDIS (n= 962) and DIREVA (n=420). Subgroups were also assessed in two other Indian cohorts, Ahmedabad (n = 187) and PHENOEINDY-2 (n = 205).ResultsBoth Indian and European young type 2 diabetes patients were predominantly classified into severely insulin-deficient (SIDD) and mild obesity-related (MOD) subgroups, while the severely insulin-resistant (SIRD) and mild age-related (MARD) subgroups were rare. In WellGen, SIDD (53%) was more common than MOD (38%), contrary to figures in Europeans (Swedish: 26% vs 68%, Finnish: 24% vs 71% respectively). A higher proportion of SIDD compared to MOD was also seen in Ahmedabad (57% vs 33%) and in PHENOEINDY-2 (67% vs 23%). Both in Indians and Europeans, the SIDD subgroup was characterized by insulin deficiency and hyperglycemia, MOD by obesity, SIRD by severe insulin resistance and MARD by mild metabolic-endocrine disturbances. In WellGen, nephropathy and retinopathy were more prevalent in SIDD compared to MOD while the latter had higher prevalence of neuropathy.Conclusions /InterpretationOur data identified insulin deficiency as the major driver of type 2 diabetes in young Indians, unlike in young European patients in whom obesity and insulin resistance predominate. Our results provide useful clues to pathophysiological mechanisms and susceptibility to complications in young Indian type 2 diabetes, and suggest a need to review management strategies. |
| Databáze: | OpenAIRE |
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