The Use of Incretin-Based Therapy in Asian Patients with Diabetes

Among the approximately 382 million people who have type 2 diabetes (T2DM) worldwide, approximately 20% live in South-East Asia and 65.1 million live in India. Asian populations are racially, demographically, culturally and socioeconomically heterogeneous. Researchers have identified unique trends in Asians diagnosed with T2DM.

In Asia in general, T2DM develops over a much shorter time, in younger patients and in people who have lower body mass indexes (BMI) than in other parts of the world. South-Asian T2DM patients generally have lower BMI but more visceral fat at given BMI or waist circumference, creating a greater likelihood that hypoadiponectinemia plays a role. East-Asian T2DM patients tend to have predominant insulin secretory defect compared to their white counterparts (who have higher rates of insulin resistance). A consultant endocrinologist described the face of diabetes in Asia in a comprehensive review article published in the January-February issue of the Indian Journal of Endocrinology and Metabolism.

In most parts of the world, incretin-based therapy is an emergent strategy for T2DM due to its efficacy, absence of hypoglycemia as a side effect, and weight-neutral or weight-reducing properties. Researchers have noted some ethnic differences in response to incretins.

The author cites a few small studies and a meta-analysis primarily conducted in Asian subjects. These studies suggest that Asians may experience better HbA1c reduction with incretin-based therapies than otherwise similar Caucasian, African-American and Hispanic populations.

He notes that the meta-analysis was conducted primarily in East-Asians and cannot be extrapolated to South-Asians, where insulin resistance is a larger factor. Although the exact reasons for better response to incretin-based therapies are unclear, the authors indicates that the fact that East-Asians are less obese and possess “thrifty” genotype may create more insulin secretory defects compared to non-Asians and increase incretin effectiveness.

More studies are needed to determine if the exaggerated response to incretins is also present in South-Asians.