Anjana Ranjit Mohan, Siddiqui Moneeza Kalhan, Jebarani Saravanan, Vignesh Mani Arun, Kamal Raj Nithyanantham, Unnikrishnan Ranjit, Pradeepa Rajendra, Panikar Vijay K, Kesavadev Jothydev, Saboo Banshi, Gupta Sunil, Sosale Aravind R, Seshadri Krishna G, Deshpande Neeta, Chawla Manoj, Chawla Purvi, Das Sidhartha, Behera Manoranjan, Chawla Rajeev, Nigam Anant, Gupta Arvind, Kovil Rajiv, Joshi Shashank R, Agarwal Sanjay, Bajaj Sarita, Pearson Ewan R, Doney Alexander S F, Palmer Colin N A, Mohan Viswanathan
Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India.
Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom.
Diabetes Technol Ther. 2022 Mar;24(3):190-200. doi: 10.1089/dia.2021.0277. Epub 2022 Jan 5.
To assess the prescribing patterns and response to different classes of antihyperglycemic agents in novel clusters of type 2 diabetes (T2D) described in India. 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 ( = 13,247). 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. 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.
为评估印度描述的新型2型糖尿病（T2D）集群中不同类别降糖药物的处方模式及反应。我们试图在2013年10月至2020年12月期间在印度各地15家糖尿病诊所登记的32867例新诊断（诊断后2年内）的T2D患者中，通过利用6个临床相关变量的k均值聚类法，复制先前描述的T2D集群。纳入药物反应分析的是随访糖化血红蛋白（HbA1c）达2年的个体（n = 13247）。在纳入研究的32867名参与者中，20779名（63.2%）为男性。诊断时的平均年龄为45岁，基线时的平均HbA1c为8.9%。先前在印度描述的相同四个集群得以复制。40%的研究参与者属于轻度年龄相关性糖尿病集群，其次是胰岛素抵抗肥胖糖尿病（27%）、严重胰岛素缺乏糖尿病（21%）以及胰岛素抵抗和胰岛素缺乏合并糖尿病（12%）集群。除胰岛素外，最常用的降糖药物是磺脲类、二甲双胍和二肽基肽酶-4抑制剂。虽然各集群间药物在HbA1c降低方面存在显著差异，但这些差异很大程度上是由基线（治疗前）HbA1c差异驱动的。在这个新队列中，我们能够可靠地复制先前在亚洲印度人中描述的T2D的四种亚型。处方模式显示所有集群中新型降糖药物的使用有限。需要进行随机临床试验以确定各集群间的药物反应差异。
