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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 utilizing 6 clinically relevant variables. Individuals who had follow-up glycated hemoglobin (HbA1c) up to 2 years were included for the drug response analysis (n = 13,247). Results: Among the 32,867 participants included in the study, 20,779 (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 cluster, followed by insulin-resistant obese diabetes (27%), severe insulin-deficient diabetes (21%), and combined insulin-resistant and insulin-deficient diabetes (12%) clusters. The most frequently used antihyperglycemic agents were sulfonylureas, 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 (pretreatment) 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. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the secular trends in the prevalence of diabetes and pre-diabetes from two cross-sectional studies done 11 years apart, in rural Tamil Nadu. Methods: The Telemedicine PRoject for screENing Diabetes and its complications in rural Tamil Nadu(TREND) study is a cross-sectional survey that screened 14,117 individuals aged ≥ 18 years between 2018–2021. TREND was conducted in 30 villages of Chengalpattu/Kancheepuram districts of Tamil Nadu in Southern India. The prevalence of diabetes and prediabetes was compared with an earlier study the Chunampet Rural Diabetes Prevention Project(CRDPP) which screened 23,380 individuals aged ≥ 20 years between 2006–2010 using similar methodology, in 42 villages in the same area. Diabetes and prediabetes were diagnosed using the WHO criteria. Results: Individuals screened in TREND were significantly older (43.7 ± 14.5 vs.40.5 ± 15.2 years) and had higher BMI (23 ± 5 vs.21.4 ± 4.1) compared to CRDPP participants. The age and gender adjusted prevalence of diabetes increased from 5.3% to 13.7% (158.5% increase) during this 11-year period. There was a significant increase in prevalence of both self-reported diabetes (3.8% to 9.7%) and newly diagnosed diabetes (1.5% to 4.0%), but a decrease in prevalence of prediabetes from 16.7% to 8.4% (49.7% decrease) during the 11-year period. Age, male sex, BMI, formal education, occupations other than agriculture, family history of diabetes, and systolic blood pressure were significant predictors of diabetes. Conclusions: The prevalence of diabetes among adults in rural south India has dramatically increased while that of prediabetes, has decreased, over a 11-year period. The decrease in prevalence of prediabetes might suggest a future slowing down of the epidemic. [ABSTRACT FROM AUTHOR]