Genes, diabetes and treatment: Are we any close to solution?

M Somasekhar

Our genes tell many tales. They hold many secrets too. Scientists have been unlocking useful data to find answers to many issues and finding important clues to find treatments to difficult diseases.

Indian researchers have taken a close look at genetic data among select population to find a way of assessing if a person has type 1 diabetes. They have used a ‘Genetic Risk Score’ to arrive at this conclusion.  

The University of Exeter in UK has developed this genetic risk score. The researchers from the Hyderabad-based, CSIR- Centre for Cellular & Molecular Biology (CCMB) and the KEM Hospital and Research Centre, Pune; and the UK University have done a study recently and published in the journal Scientific Reports. 

As we are aware, India is virtually the diabetes capital of the world with the recent statistics showing about 73 million adults suffering from it. Within India, Hyderabad has very high incidence of 16.6 percent of its adult population too as per data available.

The other big challenge in diabetes, a lifestyle disease, which is Non-communicable is the nature of its occurrence. There are two types-type 1 & 2. It is widely believed that only children and adolescents get type-1 diabetes and obese and older, above 40 get type-2 diabetes. 

However, recent findings have shown that type-1 diabetes can occur later in life, while type-2 diabetes is on the rise among younger and thinner Indians. Distinguishing the two types of diabetes, has therefore, become more complex. The two types follow different treatment regime with type-1 diabetes needing lifelong insulin injections but type-2 diabetes often being managed with diet or drug treatment.

Hence, proper diagnosis of the type of diabetes is emerging as the key to the quality and relevant treatment regime. This will determine the cost, duration and agony as well in the management of the problem feel experts.

Misdiagnosis of diabetes could be an issue in India because of features of diabetes in Indians which might vary from the standard western textbooks.

Given the genetic diversity of the population of India, the study’s results need to be validated in other ethnic groups of the country too, says  Dr Rakesh K Mishra, Director of CCMB.

“Since more than 20 per cent of people with type 1 diabetes below the age of 15 years of age are in India, developing a genetic test kit to reliably detect type 1 from type 2 diabetes holds a lot of significance for the country,”, he added

The Genetic Risk Score:

It is based on detailed genetic information related to the increased chances of developing type 1 diabetes among European populations.

Will it be useful in Indian populations? 

In the study published in Scientific Reports, researchers have analysed whether the European risk score is effective in diagnosing type 1 diabetes in Indians. The team analysed 262 people with type 1 diabetes, 352 people with type 2 diabetes, and 334 people without diabetes, from Pune. All were of Indian (Indo-European) ancestry. 

Outcomes from the Indian populations were compared with those of Europeans from the Wellcome Trust Case Control Consortium study. They found that the test is effective in diagnosing the right type of diabetes in Indians, even in its current form, which is based on European data. Authors also found genetic differences between the populations which mean the test could be further improved to enhance outcomes for Indian populations.

Dr Richard Oram, of the University of Exeter Medical School, said: “Diagnosing the right diabetes type is an increasingly difficult challenge for clinicians, as we now know that type 1 diabetes can occur at any age. This task is even harder in India, as more cases of type 2 diabetes occur in people with low BMI. We now know that our genetic risk score is an effective tool for Indians, and can help get people on the treatment they need to avoid life threatening complications such as diabetic ketoacidosis and to achieve the best health outcomes.”

Dr Chittaranjan Yajnik of the KEM Hospital & Research Centre, agrees with Dr Oram. He said, that the escalating epidemic of diabetes in young Indians makes it imperative that we diagnose the type of diabetes correctly to avoid mistreatment and its long term biological, social and economic implications. The new genetic tool will be a great help in this.  “We look forward to using this test in diabetic patients from different parts of India where the physical characteristics of diabetic patients differ from the standard description,” he added.

The researchers found nine genetic areas (called the SNPs or Single nucleotide polymorphism) that correlate with type 1 diabetes both in Indian and European populations, and can be used to predict the onset of type 1 diabetes in Indians. Dr G R Chandak, Chief Scientist leading the study at the CCMB said. 

“It’s interesting to note that different SNPs are more abundant among Indian and European patients. This opens up the possibility that environmental factors might be interacting with these SNPs to cause the disease,” he added.

SNPs are the most common type of genetic variation among people. Each SNP represents a difference in a single DNA (Deoxyribonucleac acid) building block, which in turn is called a nucleotide. 

Somasekhar Mulugu, former Associate Editor & Chief of Bureau of The Hindu BusinessLine, is a well-known political, business and science writer and analyst based in Hyderabad.

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