Early-onset Type 2 Diabetes Mellitus and Cardiometabolic Risk in India

Abstract

Introduction: The Indian patient phenotype with early-onset type 2 diabetes mellitus (T2DM) merits a more holistic understanding of the cardiometabolic risk profile. As per the principles of precision medicine, such understanding can help appraise the clinical place of interventions like sodium-glucose cotransporter-2 inhibition (SGLT2-i), for this population. Methodology: This observational study represents cases with T2DM, aged ≤40 years, who were newly initiated on empagliflozin on top of standard therapy. Analysis was performed for demographics and clinical characteristics at baseline and 3 months following empagliflozin use. Parameters for analysis included clinical and laboratory indicators of glycemic control, adiposity, insulin sensitivity, inflammation, and derived indicators for cardiometabolic risk. Descriptive statistics have been used for the analysis. Further, subgroups by body mass index (BMI) status (< or ≥25 kg/m2) have been compared for certain continuous variables, using an unpaired t-test. Results: The study included 70 patients, with a mean age of nearly 36 years. The mean BMI was 25.57 kg/m2; approximately 43% of patients had a BMI ≥25 kg/m2. The nonobese patients had a higher triglyceride-glucose index and lower fasting insulin levels, compared to obese patients. The risk of advanced nonalcoholic steatohepatitis was low in this population. The addition of empagliflozin to background therapy improved the HbA1c level by 1.21% with 44% goal-achievement and other metabolic parameters. Weight loss and anthropometric changes were modest. Empagliflozin use was associated with meaningful improvements in cardiometabolic parameters, including triglyceride-glucose index, atherogenic index of plasma, homeostatic model assessment for insulin resistance, quantitative insulin-sensitivity check index, visceral adiposity index, Fibrosis-4 index, and aspartate transaminase-to-platelet ratio index scores, in this population. Insulin resistance remained higher than normal in most patients, despite improvement with empagliflozin use over 3 months. Conclusion: The study findings for people with early-onset T2DM in India indicate: (1) the need for opportunistic screening for T2DM at an earlier age; (2) a high prevalence of insulin resistance regardless of obesity status; (3) meaningful improvements in overall cardiometabolic risk profile with SGLT2-i use; and (4) the importance of long-term optimization of diabetes care in this population.