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

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 mus...

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Autores principales: Ke, Calvin, Narayan, K. M. Venkat, Chan, Juliana C. N., Jha, Prabhat, Shah, Baiju R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9067000/
https://www.ncbi.nlm.nih.gov/pubmed/35508700
http://dx.doi.org/10.1038/s41574-022-00669-4
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author Ke, Calvin
Narayan, K. M. Venkat
Chan, Juliana C. N.
Jha, Prabhat
Shah, Baiju R.
author_facet Ke, Calvin
Narayan, K. M. Venkat
Chan, Juliana C. N.
Jha, Prabhat
Shah, Baiju R.
author_sort Ke, Calvin
collection PubMed
description 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.
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spelling pubmed-90670002022-05-04 Pathophysiology, phenotypes and management of type 2 diabetes mellitus in Indian and Chinese populations Ke, Calvin Narayan, K. M. Venkat Chan, Juliana C. N. Jha, Prabhat Shah, Baiju R. Nat Rev Endocrinol Review Article 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. Nature Publishing Group UK 2022-05-04 2022 /pmc/articles/PMC9067000/ /pubmed/35508700 http://dx.doi.org/10.1038/s41574-022-00669-4 Text en © Springer Nature Limited 2022 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Review Article
Ke, Calvin
Narayan, K. M. Venkat
Chan, Juliana C. N.
Jha, Prabhat
Shah, Baiju R.
Pathophysiology, phenotypes and management of type 2 diabetes mellitus in Indian and Chinese populations
title Pathophysiology, phenotypes and management of type 2 diabetes mellitus in Indian and Chinese populations
title_full Pathophysiology, phenotypes and management of type 2 diabetes mellitus in Indian and Chinese populations
title_fullStr Pathophysiology, phenotypes and management of type 2 diabetes mellitus in Indian and Chinese populations
title_full_unstemmed Pathophysiology, phenotypes and management of type 2 diabetes mellitus in Indian and Chinese populations
title_short Pathophysiology, phenotypes and management of type 2 diabetes mellitus in Indian and Chinese populations
title_sort pathophysiology, phenotypes and management of type 2 diabetes mellitus in indian and chinese populations
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9067000/
https://www.ncbi.nlm.nih.gov/pubmed/35508700
http://dx.doi.org/10.1038/s41574-022-00669-4
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