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Lean Diabetic Phenotype Could Translate to Poorer Disease Outcomes
Researchers from the National Heart Centre Singapore (NHCS) discover a lean diabetic phenotype in Asian patients with heart failure, who could suffer from more disease complications. Their new trial, ADOPT, aims to identify these individuals and test an intensive preventive treatment that could improve their outcomes.

The links between obesity, diabetes and cardiovascular disease have been widely investigated, sparking national campaigns and discussions about eating habits, exercise, and weight management in many countries.

It is believed that obesity is a major risk factor contributing to the development of diabetes and cardiovascular disease. Therefore, individuals are often advised to monitor their weight closely and medical professionals often use measures such as the body mass index (BMI), used to determine if an individual is obese, to assess one’s risk of developing more serious conditions.

New research from the National Heart Centre Singapore (NHCS) could completely change the way we assess the likelihood of developing of diabetes and heart disease, as well as how we predict the disease outcomes of patients. The study was led by Professor Carolyn Lam, Senior Consultant from the Department of Cardiology, NHCS and Professor of Cardiovascular Academic Clinical Programme at SingHealth Duke-NUS Academic Medical Centre.

Professor Lam and her team found that in Asian patients with heart failure, there exists a unique lean diabetic phenotype, and that these patients had a high prevalence of diabetes although they have low BMI. This is in contrast with observations of patients in Western populations, where diabetes risk is tied closely with BMI. In comparison, Asian patients were three times more likely to develop diabetes despite having lower BMI.

These lean diabetic patients were more prone to hospitalisation and death than other patient groups, especially if they had large waist-to-height ratios. According to Dr Chanchal Chandramouli, a Research Fellow at NHCS, “the lean diabetic cluster was associated with the worst quality of life and composite outcomes, with 79 percent greater risk of hospitalisation and mortality at one year, compared with other clusters.”

Based on these worrying statistics, researchers from NHCS are collaborating with investigators from other Asian countries including Malaysia, China, Taiwan, India and United Arab Emirates, on a multinational prospective study named the Asian Diabetes Outcome Prevention Trial (ADOPT). This trial seeks first to identify diabetic patients who are at high risk of developing cardiovascular disease using blood biomarker-based screening, and to assess the effectiveness of a proposed intensive treatment in preventing cardiovascular events in these patients. ADOPT will be conducted over four years and aims to include 2,400 volunteers.

Clinical Associate Professor Bee Yong Mong, the country head of ADOPT in Singapore and Senior Consultant at the Department of Endocrinology in Singapore General Hospital (SGH), is hopeful that “early detection of high-risk patients for targeted intervention will be key to reducing this complication”, with the complications referring to poorer health outcomes and lifestyle restrictions for patients displaying the lean diabetic heart failure phenotype.

On the potential benefits of the study, Professor Lam, who is also the Principal Investigator of ADOPT, says, “If ADOPT proves that a simple blood test can identify individuals with diabetes who will benefit from intensive preventive therapy with commonly available medications, results can directly impact clinical practice not only in Singapore, but in other parts of the world.”

The ADOPT study is already underway in Singapore, having recruited its first group of subjects in August this year. Given the substantial disease burden of obesity, diabetes and cardiovascular disease, the findings of this study would likely help us learn more about the ways we diagnose and treat these diseases, and could help improve disease outcomes in the future.


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