Using genetic tools could pave the way for better diagnosis and treatment of diabetes in Indians, according to new research.

Misdiagnosis of diabetes could be an issue in India because the features might vary from that in standard western textbooks. Until recently, it was widely believed that type 1 diabetes appeared in children and adolescents, and type 2 diabetes in obese and older (typically after 45 years of age). However, recent findings have shown that type 1 diabetes can occur later in life, while type 2 diabetes is on the rise among younger and thinner Indians.

Distinguishing the two types of diabetes has therefore, become more complex. The two types follow different treatment regime with type 1 diabetes needing lifelong insulin injections but type 2 diabetes often being managed with diet or tablet treatment. Misclassification of the type of diabetes may lead to sub-standard diabetes care and possible complications.

A new publication by researchers at the KEM Hospital, Pune, CSIR-Centre for Cellular and Molecular Biology (CCMB), Hyderabad, and the University of Exeter in the UK shows that a genetic risk score is effective in diagnosing type 1 diabetes in Indians.

The genetic risk score, developed by the University of Exeter, considers detailed genetic information known to increase the chance of developing type 1 diabetes. The score may be used at the time of diabetes diagnosis to help decide if someone has type 1 diabetes.

The authors also found genetic differences between the populations which mean the test could be further improved to enhance outcomes for Indian populations.

Richard Oram, of the University of Exeter Medical School, said: “Diagnosing the right diabetes type is an increasingly difficult challenge for clinicians, as we now know that type 1 diabetes can occur at any age. This task is even harder in India, as more cases of type 2 diabetes occur in people with low BMI.”

The authors found nine genetic areas (called the SNPs) that correlate with type 1 diabetes both in Indian and European populations. GR Chandak, Chief Scientist leading the study at the CSIR-Centre for Cellular and Molecular Biology (CCMB), said: “It’s interesting to note that different SNPs are more abundant among Indian and European patients. This opens up the possibility that environmental factors might be interacting with these SNPs to cause the disease.”

Given the genetic diversity of the population of India, the results need to be validated in other ethnic groups of the country too.

Rakesh K Mishra, Director of the CSIR-Centre for Cellular and Molecular Biology (CCMB), said: “Since more than 20 per cent of people with type 1 diabetes below the age of 15 years of age are in India, developing a genetic test kit to reliably detect type 1 from type 2 diabetes holds a lot of significance for the country.”

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