Pathophysiology, phenotypes and management of type 2 diabetes mellitus in Indian and Chinese populations

Prevalence of type 2 diabetes mellitus (T2DM) is increasing substantially in India and China. This Review discusses the epidemiology, phenotypes and pathogenesis of T2DM in India and China and evaluates options for optimal pharmacological management. Nearly half of all adults with type 2 diabetes mellitus (T2DM) live in India and China. These populations have an underlying predisposition to deficient insulin secretion, which has a key role in the pathogenesis of T2DM. Indian and Chinese people might be more susceptible to hepatic or skeletal muscle insulin resistance, respectively, than other populations, resulting in specific forms of insulin deficiency. Cluster-based phenotypic analyses demonstrate a higher frequency of severe insulin-deficient diabetes mellitus and younger ages at diagnosis, lower beta-cell function, lower insulin resistance and lower BMI among Indian and Chinese people compared with European people. Individuals diagnosed earliest in life have the most aggressive course of disease and the highest risk of complications. These characteristics might contribute to distinctive responses to glucose-lowering medications. Incretin-based agents are particularly effective for lowering glucose levels in these populations; they enhance incretin-augmented insulin secretion and suppress glucagon secretion. Sodium-glucose cotransporter 2 inhibitors might also lower blood levels of glucose especially effectively among Asian people, while alpha-glucosidase inhibitors are better tolerated in east Asian populations versus other populations. Further research is needed to better characterize and address the pathophysiology and phenotypes of T2DM in Indian and Chinese populations, and to further develop individualized treatment strategies.

Automated summary

The prevalence of type 2 diabetes mellitus (T2DM) is increasing in India and China, which might be attributed to deficient insulin secretion and hepatic or skeletal muscle insulin resistance. Indian and Chinese populations have a higher frequency of severe insulin-deficient diabetes and lower beta-cell function, insulin resistance, and BMI compared to European populations. These characteristics might contribute to distinctive responses to glucose-lowering medications.