Type 2 diabetes mellitus (T2DM) is the most common form of diabetes characterized by elevated levels of plasma glucose caused by impairment in both insulin secretion and action. It is becoming an epidemic leading to various complications and its prevalence and incidence are increasing at an alarming rate in developing countries like India, raising a major public health concern. Both the genetic and environmental factors play a strong role in the manifestation of this complex genetic disorder. In the recent years, there has been a spate of molecular genetic investigations, including whole genome scans, to test the association of genetic variants with T2DM in different patho-physiological pathways. A large number of candidate genes have been identified to be associated with T2DM, albeit only a couple of them show consistency in association in different populations/ethnic groups. Given relatively high risk for T2DM in India and immense genetic heterogeneity and substructure of the constituent populations, the number of studies is too small to be able to characterize the genetic basis of the disease in India. The recent dramatic increase in number of affected people indicates that lifestyle factors related to urbanization and sedentary occupations may be particularly important in triggering the genetic elements that cause this type of diabetes. Therefore, it is imperative to precisely establish the underlying genetic and environmental factors behind this complex genetic disorder so that preventive measures can be initiated. We have attempted to review the molecular genetic studies conducted, till date, globally on T2DM along with the epidemiological, environmental and ethnic factors implicated in the manifestation of T2DM.

We replicated the significant association of rs1801278 and rs3792267 SNPs of the IRS1 and CAPN10 genes with T2DM in the population of Hyderabad. Despite the known biological significance of the PPARG gene and a sufficient statistical power of the present study, we could not replicate the association of PPARG with T2DM in our high-risk population. Given the vast ethnic, geographic, and genetic heterogeneity of the Indian population, many more studies are needed covering the ethnic and geographic heterogeneity of India to enable identification of an Indian-specific profile of genes associated with T2DM.

Background & objectives:Polycystic ovary syndrome (PCOS) is the most common reproductive endocrine disorder of premenopausal women. Given the phenotypic overlap between PCOS and type 2 diabetes mellitus (T2DM), this study was carried out to investigate whether genes implicated in T2DM were also involved in the susceptibility to PCOS among women from southern India.Methods:A total of 248 women with PCOS and 210 healthy women as controls were genotyped for a panel of 15 single nucleotide polymorphisms (SNPs) from the nine T2DM genes, such as TCF7L2, IGF2BP2, SLC30A8, HHEX, CDKAL1, CDKN2A, IRS1, CAPN10 and PPARG, on Sequenom MassARRAY platform.Results:None of the 15 SNPs were found to be significantly associated with PCOS after Bonferroni correction for multiple testing, either in the univariate or multivariate context. The cumulative effect of risk alleles observed with reference to T2DM was also not seen with reference to PCOS.Interpretation & conclusions:The nine T2DM genes considered in this exploratory study might not be the primary susceptibility factors for PCOS among Indian women. Our results supplement the lack of evidence of the association of T2DM genes with PCOS among the Chinese and Caucasians hinting at the possible universality of this pattern. Specifically designed comprehensive studies that include women with T2DM and PCOS are required to explore the precise role of the diabetes genes.

Genome-wide association studies identified novel genes associated with T2DM which have been replicated in different populations. We try to examine here if certain frequently replicated SNPs of Insulin growth factor 2 m-RNA binding protein 2 (IGF2BP2) (rs4402960, rs1470579) and Solute Carrier family 30 member 8 (SLC30A8) (rs13266634) genes, known to be implicated in insulin pathway, are associated with T2DM in the population of Hyderabad, which is considered to be a diabetic capital of India. Genotyping of the 1379 samples, 758 cases and 621 controls, for the SNPs was performed on sequenom massarray platform. The logistic regression analysis was done using SPSS software and the post-hoc power of the study was estimated using G power. The allele and genotype frequencies were similar between cases and controls, both for SNPs of IGF2BP2 and SLC30A8 genes. Logistic regression did not reveal significant allelic or genotypic association of any of the three SNPs with T2DM. Despite large sample size and adequate power, we could not replicate the association of IGF2BP2 and SLC30A8 SNPs with T2DM in our sample from Hyderabad (A.P.), India, albeit another study based on much larger sample but from heterogeneous populations from the northern parts of India showed significant association of two of the above 3 SNPs, suggesting variable nature of susceptibility of these genes in different ethnic groups. Although the IGF2BP2 and SLC30A8 genes are important in the functional pathway of Insulin secretion, it appears that these genes do not play a significant role in the susceptibility to T2DM in this population.

Background & objectives:The genome-wide association studies (GWAS) have shown an association of type 2 diabetes mellitus (T2DM) with several novel genes. We report here the findings on the pattern of genetic association of three genes (CDKAL1, CDKN2A/B and HHEX) with T2DM in the population of Hyderabad, south India.Methods:A sample of 1379 individuals (758 T2DM cases and 621 controls) from Hyderabad, India, were genotyped for five single nucleotide polymorphisms (SNPs) of CDKAL1 (rs7754840, rs7756992) CDKN2A/B (rs10811661) and HHEX (rs1111875, rs7923837) genes on Sequenom Mass Array platform.Results:The risk allele frequencies of the CDKAL1 and CDKN2A/B SNPs were relatively higher in cases than in the controls and the logistic regression analysis yielded significant odds ratios suggesting that the variant alleles conferred risk for developing T2DM in this population. The HHEX gene did not show either allelic or genotypic association with T2DM. The multivariate logistic regression analysis with reference to both alleles and genotypes of CDKAL1 SNPs showed significant association, suggesting an important role for this gene in the T2DM pathophysiology.Interpretation & conclusions:A significant association was seen of all the three SNPs of CDKAL1 and CDKN2A/B genes with T2DM but none of the two SNPs of HHEX. Further studies are required to cross-validate our findings in a relatively larger sample. It is also necessary to explore other SNPs of HHEX gene to unequivocally establish the pattern of association of this gene with T2DM in this population.

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perspective. Both ICERs were between 1w2 times GDP per capita, far below the local threshold of 3 times GDP per capita in 2018 (CNY 193,932). Acquisition cost of pertuzumab is partially offset by the prevention of disease recurrences over the time. Cost for managing recurrences in PHT was 42% lower than that in HT group. Probabilistic sensitivity analysis showed that PHT was more cost-effective in more than 70% simulations at local threshold regardless of the perspective. Conclusions: Compared to HT, PHT is more cost-effective in the adjuvant treatment for patients with HER2-positive early breast cancer at high risk of recurrence in China.