Prescribing Patterns and Response to Antihyperglycemic Agents Among Novel Clusters of Type 2 Diabetes in Asian Indians.

Aim: To assess the prescribing patterns and response to different classes of antihyperglycemic agents in novel clusters of type 2 diabetes (T2D) described in India. Materials and Methods: We attempted to replicate the earlier described clusters of T2D, in 32,867 individuals with new-onset T2D (within 2 years of diagnosis) registered between October 2013 and December 2020 at 15 diabetes clinics located across India, by means of k-means clustering utilizing 6 clinically relevant variables. Individuals who had follow-up glycated hemoglobin (HbA1c) up to 2 years were included for the drug response analysis (n = 13,247). Results: Among the 32,867 participants included in the study, 20,779 (63.2%) were males. The average age at diagnosis was 45 years and mean HbA1c at baseline was 8.9%. The same four clusters described in India earlier were replicated. Forty percent of the study participants belonged to the mild age-related diabetes cluster, followed by insulin-resistant obese diabetes (27%), severe insulin-deficient diabetes (21%), and combined insulin-resistant and insulin-deficient diabetes (12%) clusters. The most frequently used antihyperglycemic agents were sulfonylureas, metformin, and dipeptidyl peptidase-4 inhibitors apart from insulin. While there were significant differences in HbA1c reduction between drugs across clusters, these were largely driven by differences in the baseline (pretreatment) HbA1c. Conclusions: In this new cohort, we were able to reliably replicate the four subtypes of T2D earlier described in Asian Indians. Prescribing patterns show limited usage of newer antihyperglycemic agents across all clusters. Randomized clinical trials are required to establish differential drug responses between clusters.

Inter-generation comparison of type-2 diabetes in 73 Indian families.

AIMS AND OBJECTIVE: To study type 2 diabetics in 2 generations in the same family and to see if there are any significant differences in their presentations. The study also focused on the non-diabetic siblings to see if there were any differences between them. MATERIAL AND METHODS: Criteria for inclusion: 1. Proband case should have a parent who is a diabetic, 2. Proband case should have at least one sibling who is not diabetic. Entire families of such cases fulfilling the above criteria were included in the study. A detailed questionnaire was filled. This was followed by an examination of all anthropometric measurements like height, weight, waist circumference, hip circumference and blood pressure. Venous blood samples for glucose measurement (fasting and post prandial), HbA1c, renal profile, lipid profile and insulin levels were collected. Urine sample was collected in appropriate containers for microalbuminuria, albumin/creatinine ratio. RESULTS: The study included 73 families, with a total of 307 members (159 male and 148 female). 92 were from 1st generation and 215 from 2nd generation. Of these 182 were diabetics, 81 from 1st generation and 151 from 2nd generation (95 males and 87 females). 125 were non diabetics, 9 from 1st generation and 116 from the 2nd generation (64 males and 61 females). The mean age of onset of diabetes in 1st generation was 55.95 years (SD +/- 9.98) and in 2nd generation was 38.4 years (SD +/- 9.2) (p<0.0001). Body mass index (BMI), waist circumference, Wasist-hip ratio (W/H ratio) and triglycerides, HDL and blood pressure individually did not show any significant differences between the diabetics in both generations. The incidence of metabolic syndrome as per ATPIII criteria was 75.9 % among the 1st generation diabetics. There were only 9 non-diabetics in the first generation and this number was small to derive any statistical significance. Comparison between diabetics and non diabetics in the 2nd generation showed that the incidence of metabolic syndrome as per ATPIII criteria was significantly higher among the diabetics at 62.63% as against 28.45% in the non diabetics. BMI, W/H ratio and lipid profile individually did not show any significant differences between the diabetics and non diabetics. CONCLUSIONS: This study shows that the age of onset of diabetes is much earlier in the present generation being 38.4 years (SD +/- 9.2), as compared to 55.95 years (SD +/- 9.98) in the previous generation. There were no other significant differences between the two generations. In the present generation the incidence of metabolic syndrome as per ATPIII criteria was a significant risk factor for the development of diabetes. 62.63% of the diabetic siblings had metabolic syndrome as compared to 28.45% in the nondiabetic siblings. There were no other significant parameters for early detection of diabetes in this group.