Pathophysiology, phenotypes and management of type 2 diabetes mellitus in Indian and Chinese populations

• Type of Material: Article
• Authors: Kabayam Venkat Narayan, Emory University; Calvin Ke, University of Toronto; Venkat KM Narayan, Emory University; Juliana CN Chan, Chinese University of Hong Kong; Prabhat Jha, University of Toronto; Baiju R Shah, University of Toronto
• Language: English
• Date: 2022-05-04
• Publisher: NATURE PORTFOLIO
• Publication Version: Final Published Version
• Copyright Statement: © Springer Nature Limited 2022
• Final Published Version (URL): http://dx.doi.org/10.1038/s41574-022-00669-4
• Title of Journal or Parent Work: NATURE REVIEWS ENDOCRINOLOGY
• Volume: 18
• Issue: 7
• Start Page: 413
• End Page: 432
• Grant/Funding Information: C.K. was supported by the Canadian Institutes of Health Research and the South Asian Network Supporting Awareness and Research.
• Keywords: Endocrinology & Metabolism; HELICOBACTER-PYLORI INFECTION; Life Sciences & Biomedicine; COTRANSPORTER 2 INHIBITORS; INSULIN-RESISTANCE; PIOGLITAZONE CLINICAL-TRIAL; CARDIOVASCULAR OUTCOMES; Science & Technology; DIPEPTIDYL PEPTIDASE-4 INHIBITORS; ISLET AMYLOID POLYPEPTIDE; GENOME-WIDE ASSOCIATION; BETA-CELL FUNCTION; IMPAIRED GLUCOSE-TOLERANCE
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

Nearly half of all adults with type 2 diabetes mellitus (T2DM) live in India and China. These populations have an underlying predisposition to deficient insulin secretion, which has a key role in the pathogenesis of T2DM. Indian and Chinese people might be more susceptible to hepatic or skeletal muscle insulin resistance, respectively, than other populations, resulting in specific forms of insulin deficiency. Cluster-based phenotypic analyses demonstrate a higher frequency of severe insulin-deficient diabetes mellitus and younger ages at diagnosis, lower β-cell function, lower insulin resistance and lower BMI among Indian and Chinese people compared with European people. Individuals diagnosed earliest in life have the most aggressive course of disease and the highest risk of complications. These characteristics might contribute to distinctive responses to glucose-lowering medications. Incretin-based agents are particularly effective for lowering glucose levels in these populations; they enhance incretin-augmented insulin secretion and suppress glucagon secretion. Sodium–glucose cotransporter 2 inhibitors might also lower blood levels of glucose especially effectively among Asian people, while α-glucosidase inhibitors are better tolerated in east Asian populations versus other populations. Further research is needed to better characterize and address the pathophysiology and phenotypes of T2DM in Indian and Chinese populations, and to further develop individualized treatment strategies.