Prescribing Patterns and Response to Antihyperglycemic Agents Among Novel Clusters of Type 2 Diabetes in Asian Indians

Abstract

AIM:To assess the prescribing patterns and response to different classes of antihyperglycemic agents in novel clusters of type 2 diabetes (T2D) described in India. MATERIALS AND METHODS: 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 utilising six clinically relevant variables. Individuals who had followup HbA1c upto 2 years were included for the drug response analysis (n=13,247). RESULTS: Among the 32,867 participants included in the study, 20779 (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 [MARD] cluster, followed by Insulin Resistant Obese Diabetes [IROD] (27%), Severe Insulin Deficient Diabetes [SIDD] (21%) and Combined Insulin Resistant and Deficient Diabetes [CIRDD] (12%) clusters. The most frequently used antihyperglycemic agents were sulphonylureas, 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 (pre-treatment) HbA1c. CONCLUSIONS: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.

A Strategic Research Framework for Defeating Diabetes in India: A 21st-Century Agenda

“…Recently, data-driven subtypes of newly diagnosed T2DM were identified in Indian populations using routine clinical data. 11 , 53 Among these novel subtypes, those characterized by insulin deficiency constituted a higher proportion of newly diagnosed T2DM in Indians than among their European counterparts. 27 Beyond clinical and biological characteristics, environmental exposures (such as air pollution and enteric pathogens) may have moderating influences.…”