Study classifies type-2 diabetes into 4 clusters; could aid more ‘precise’ treatment in India

In a finding that could facilitate a more precise treatment of the lifestyle disease, an India-based study of people with type-2 diabetes has identified four “clusters”, or novel subgroups of individuals, showing distinct characteristics. Of them, two are unique to this region.

The study, labelled ‘INSPIRED’, classified type-2 diabetes into clusters that provide insights into the factors that drive the disease in these groups. And this further helped in predicting the risk of complications and in focussing more attention on individuals with the highest risk of developing complications of diabetes, a note on the study said.

“Till now we have been treating (all) type-2 diabetes the same,” said diabetologist RM Anjana, adding that identifying sub-types would help clinicians personalise treatment, besides being able to assess if a patient would face a higher risk of eye or kidney complications, at a later stage. Anjana is Managing Director of Dr Mohan’s Diabetes Specialities Centre, Vice President of the Madras Diabetes Research Foundation (MDRF) and first author of the study.

The study was validated against the Indian Council of Medical Research-INDIAB study and the findings were similar and representative of the country, she said.

The INSPIRED study, published online in BMJ Open Diabetes Research and Care , was a collaborative project between the MDRF and Dr Mohan’s Centre, along with Scotland’s University of Dundee. The research was funded by the National Institute for Health Research (NIHR).

Recently, a Scandinavian study had identified five subtypes. Pointing to the importance of the Indian study, Colin Palmer, Chair, Department of Pharmacogenomics, School of Medicine, University of Dundee, said that treatment in India was done on guidelines based on studies in a Caucasian population. The latest study could bring in a more precise method to treating diabetes, he said.

Echoing his thoughts, Ewan Pearson, Professor, Diabetic Medicine, Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee and the senior author of the study, said it would bring in a more targeted treatment of diabetes according to the differences in people and not based on “western guidelines”.

V Mohan, Chairman of Dr Mohan’s Centre, President - MDRF and senior author of the study, said the subtypes would give doctors an early warning of sorts, in that obesity in patients was more than a weight and a heart-ailment concern — it was also a red-flag for kidney problems. Similarly, a thin patient of a certain subtype would be at risk for eye-related problems, he said, adding that the doctor could then intervene much earlier.

Four sub-types

The subgroups identified by the study included SIDD (Severe Insulin Deficient Diabetes), a group seen to be more prone to diabetic retinopathy, the study found. The other group was MARD (Mild Age-Related Diabetes), with the least use of insulin and much less prone to develop complications.

The two novel clusters described for the first time included IROD (Insulin Resistant Obese Diabetes). This group was most prone to diabetic kidney disease. And the other novel group was referred to as CIRDD (Combined Insulin Resistant and Deficient Diabetes), prone to both retinopathy and diabetic kidney disease.

The study was done on 19,084 individuals with type 2 diabetes using eight clinically relevant variables including age at diagnosis, waist circumference and HbA1c levels. Data for the analysis was from the database at Dr Mohan’s Centre, of more than 450,000 diabetes patients.

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