Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Nat Rev Endocrinol. 2022 Jul;18(7):413-432. doi: 10.1038/s41574-022-00669-4. Epub 2022 May 4.
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.
全球近一半的 2 型糖尿病（T2DM）患者生活在印度和中国。这些人群存在胰岛素分泌不足的潜在倾向，而胰岛素分泌不足在 T2DM 的发病机制中起着关键作用。与其他人群相比，印度人和中国人可能更容易出现肝脏或骨骼肌胰岛素抵抗，从而导致特定形式的胰岛素缺乏。基于聚类的表型分析表明，与欧洲人相比，印度人和中国人中严重胰岛素缺乏型糖尿病的发生率更高，诊断年龄更早，β细胞功能更低，胰岛素抵抗和 BMI 更低。在生命早期被诊断出的个体疾病进展最为迅速，并发症风险最高。这些特征可能导致对降糖药物的反应存在差异。肠促胰岛素类药物在这些人群中特别有效地降低血糖水平；它们增强肠促胰岛素增强的胰岛素分泌并抑制胰高血糖素分泌。钠-葡萄糖共转运蛋白 2 抑制剂在亚洲人群中也可能特别有效地降低血糖水平，而 α-葡萄糖苷酶抑制剂在东亚人群中的耐受性优于其他人群。需要进一步研究以更好地描述和解决印度和中国人群 T2DM 的病理生理学和表型，并进一步制定个体化治疗策略。
