Background and Aim: Sub-classification of type 2 diabetes (T2D) based on pathophysiological abnormalities is documented to facilitate better T2D management. Aim of the study was to classify 270 Indian patients with recently diagnosed T2D based on phenotype and the impact of each phenotype on the rate of remission, after a structured diabetes remission program.

Methods: We retrospectively extracted and analyzed baseline data of patients with T2D (diagnosed as per WHO criteria) enrolled for a one-year diabetes management program at the Freedom from Diabetes Clinic, India. Inclusion criteria included a recent diagnosis of T2D (<2 years). Using the homeostatic assessment model, patients were categorized into 3 sub-phenotypes: insulinopenic (high insulin sensitivity (IS) and low beta cell function (BCF)), classical (low IS and low BCF), and hyperinsulinemic (low IS and high BCF) T2D. Post-intervention, remission was defined as maintaining HbA1c<48 mmol/mol without the use of glucose-lowering medications for at least 3 months.

Results: Of the 270 patients, the majority were hyperinsulinemic (35.9%) followed by insulinopenic 17.4% and classical (13.3%) T2D. Additionally, a novel category of patients with both high IS and high BCF was observed (labeled ‘Unclassified’-33%). Hyperinsulinemic patients had the highest BMI (median 28 kg/m2), dyslipidemia, hypertension, and history of heart disease with the lowest remission rate (14.4%). One in four classical patients was on oral hypoglycemic agents and showed poor glycemic control but 25% remission. Unclassified patients showed the highest remission (28.1%).

Conclusion: Pathophysiological sub-phenotyping could assist caregivers in better management of T2D through targeted treatment options. Remission rates were observed to be better in classical and unclassified (high insulin sensitivity and beta function) T2D. Further large-scale studies to understand the unclassified group are warranted.


P.Tripathi: Board Member; Freedom from Diabetes Clinic. A.R.Vyawahare: Research Support; Freedom From Diabetes. N.S.Kadam: Research Support; Freedom from Diabetes Clinic. B.Sharma: Research Support; Freedom From Diabetes clinic. M.H.Ganla: Employee; Freedom from Diabetes Clinic. M.Das biswas: Employee; Freedom from Diabetes Clinic. B.D.Saboo: None.

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