Abstract
AimTo conduct a comprehensive review of studies of glycaemic deterioration in type 2 diabetes and identify the major factors influencing progression.MethodsWe conducted a systematic literature search with terms linked to type 2 diabetes progression. All the included studies were summarized based upon the factors associated with diabetes progression and how the diabetes progression was defined.ResultsOur search yielded 2785 articles; based on title, abstract and full‐text review, we included 61 studies in the review. We identified seven criteria for diabetes progression: ‘Initiation of insulin’, ‘Initiation of oral antidiabetic drug’, ‘treatment intensification’, ‘antidiabetic therapy failure’, ‘glycaemic deterioration’, ‘decline in beta‐cell function’ and ‘change in insulin dose’. The determinants of diabetes progression were grouped into phenotypic, ethnicity and genotypic factors. Younger age, poorer glycaemia and higher body mass index at diabetes diagnosis were the main phenotypic factors associated with rapid progression. The effect of genotypic factors on progression was assessed using polygenic risk scores (PRS); a PRS constructed from the genetic variants linked to insulin resistance was associated with rapid glycaemic deterioration. The evidence of impact of ethnicity on progression was inconclusive due to the small number of multi‐ethnic studies.ConclusionWe have identified the major determinants of diabetes progression—younger age, higher BMI, higher HbA1c and genetic insulin resistance. The impact of ethnicity is uncertain; there is a clear need for more large‐scale studies of diabetes progression in different ethnic groups.
Highlights
Type 2 diabetes is a heterogeneous, chronic progressive condition characterized by impaired beta-cell function and insulin resistance.[1]
The effect of genotypic factors on progression was assessed using polygenic risk scores (PRS); a PRS constructed from the genetic variants linked to insulin resistance was associated with rapid glycaemic deterioration
The CC genotype had a higher proportion of insulin initiation events compared with the other genotypes, and this study revealed the single nucleotide polymorphisms (SNPs) of Syntaxin IA was associated with insulin requirement in a Japanese population
Summary
Type 2 diabetes is a heterogeneous, chronic progressive condition characterized by impaired beta-cell function and insulin resistance.[1]. Obesity and reduced physical activity are important factors associated with diabetes risk.[5] In addition to these risk factors, there are many biomarkers associated with increased incidence of diabetes These are classified as glycaemic factors (HbA1c, fructosamine, glycated albumin, 1-5-anhydroglucitol), adipose-derived factors (adiponectin, leptin), hepatic derived factors (alanine aminotransferase, ferritin, insulin-like growth factor 1), endothelial-derived factors (cell adhesion molecules, tissue plasminogen activators) and inflammatory factors (c-reactive protein, interleukin-6 (IL-6), interleukin-13 (IL-13), interleukin-17 (IL-17)).[6,7,8,9,10] Many studies assessed the role of ethnicity in diabetes incidence, and the Diabetes Study of North California showed higher incidence rates in Asians compared with a White American population.[11,12,13] Genotypic factors play an important role in the development of diabetes. Studies of type 2 diabetes PRS showed a significant association with risk of type 2 diabetes after adjustment for other phenotypic factors,[15,16,17] and a study conducted among Europeans demonstrated a 9.4-fold risk for individuals in the upper vs lower 2.5% of the PRS.[14]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
