New research may improve type-2 diabetes treatment in India: Lancet study
The collaborative research was conducted by King Edward Memorial (KEM) Hospital Research Centre, Pune and Lund University in Sweden on genetic similarities and differences between subgroups of type 2 diabetes in India and Europe
India’s over 74.2 million diabetic population is likely to increase to 124.9 million people by 2045, according to the International Diabetes Federation. A latest study published in May 2023 edition of “The Lancet Regional Health-Southeast Asia” confirms that the genetic scores developed in European patients are applicable on patients in western India, though there are differences in the associations between the two populations.
The knowledge will help improve treatment of diabetic patients in India, claim the researchers.
The collaborative research was conducted by King Edward Memorial (KEM) Hospital Research Centre, Pune and Lund University in Sweden on genetic similarities and differences between subgroups of type 2 diabetes in India and Europe. The research was led by Dr Rashmi Prasad, associate professor in genomics, diabetes, and endocrinology at Lund University Diabetes Centre (LUDC) together with Prof Chittaranjan S Yajnik, director and consultant, diabetes unit at KEM Hospital Pune.
The results published are based on clinical data of 2,217 type 2 diabetes patients from WellGen study in western India and genetic data was available of 821 people of this group. As per the researchers and paper published in the Lancet Diabetes & Endocrinology in 2018, “diabetes can be divided on clinical and biochemical characteristics into five subgroups, severe auto-immune diabetes (SAID), severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), mild obesity-related diabetes (MOD) and mild age-related diabetes (MARD)”.
Though SAID is also known as type 1 diabetes, the remaining four subgroups belong to type 2 diabetes. Diabetes can be divided into the above subgroups based on clinical and biochemical characteristics and the classification is useful to guide treatment and may help predict complications.
The researchers studied genetics of type 2 diabetes subgroups in a larger cohort of Indian and Swedish patients and used genetic markers of type 2 diabetes and associated characteristics (obesity, insulin secretion, insulin resistance, lipid abnormalities, etc.). It was found that the genetic scores developed in Europeans are usable in Indians and there are broad similarities in associations when type 2 diabetes is considered as a single group. However, there are subtle differences in genetic associations of the subgroups between Indian and Swedish patients with type 2 diabetes.
Two interesting differences between Indian and Swedish cohorts refer to deposition of fat in the liver and association with vitamin B12 status. During the study, associations of genetic risk score for liver fat with 3 out of 4 subgroups in the Indian cohort but with none in Swedish was found. Vitamin B12 deficiency is common in India, related to vegetarian food habits but is uncommon in Sweden where people are traditionally meat eaters.
Fucosyltransferase (FUT) genes were associated with type 2 diabetes and with MOD subgroups only in Indians but not in the Swedish cohort. Further studies are needed to understand the mechanisms of such associations. One such study has started in Pune. In the PRIYA (Pune Rural Intervention in Young Adolescents) trial, we supplemented young rural adolescents with vitamin B12 and other micronutrients to reduce risk of diabetes in their children. Initial reports showed a beneficial effect on their brain development, future studies will investigate the effects on risk of diabetes, according to KEM Hospital officials.
Yajnik said, “We found that the commonest subgroup of diabetes in the Indian cohort was SIDD, while in Sweden it was MOD and associated with insulin resistance. This difference could be due to genetic or environmental factors. There are differences in environment and lifestyle of these two populations which reflect in body size and metabolism. These differences start from before conception and persist through life.”
Dr Rashmi Prasad, who is originally from India, said, “We found interesting examples of genetic differences between the Indian and Swedish groups in the study. Vitamin B12 deficiency may be one of the factors that drive the pathogenesis of the MOD subgroup in Indians.”
