Factoring in BMI and sex can help to avoid harmful side effects in type 2 diabetes
3 Aug 2018
Clinicians can match people with type 2 diabetes to the right drug to improve control of blood sugar and help avoid damaging side-effects, simply by factoring in characteristics such as sex and BMI into prescribing decisions, new MRC-funded research suggests.
The University of Exeter study could dramatically reduce the risk of potentially harmful side-effects such as weight gain and hypoglycaemia, at no additional cost to the NHS.
Metformin is the first line of drug treatment in type 2 diabetes, but many patients eventually need additional drugs on top of Metformin to lower their blood sugar levels. Currently, clinicians make prescribing decisions on these additional drug options based on limited available guidance. Previous research from the Exeter team revealed there is great regional variation across the UK in the prescribing of these additional drugs.
The new study, published in the journal Diabetes Care, provides a starting point for a more evidence-based approach to the prescribing of drugs after Metformin. Based on a patient’s gender and BMI, the authors found important differences in the likely success of the commonly prescribed drugs sulfonylureas and thiazolidinediones in lowering blood sugar levels, and in the risk of common side effects.
For example, obese females were far more likely to have good blood glucose control on thiazolidinediones than sulfonylureas, whilst non-obese males had the opposite result – they were far more likely to have good blood glucose control on sulfonylureas than thiazolidinediones.
Study lead author, John Dennis, of the University of Exeter Medical School, said: “Our findings are important as they provide the first evidence that personalised or ‘precision’ medicine approaches in diabetes can be based on simple patient characteristics available to any doctor, rather than expensive genetics or other technology. This simple personalised approach could be implemented immediately within the NHS without any additional cost.”
The Exeter team used anonymous data from more than 29,000 patients who had either taken part in trials or were treated in UK GP practices. By combining these datasets, the researchers showed their findings are robust and potentially applicable to many of the 3.5 million-plus people currently diagnosed with type 2 diabetes in the UK.
Dr Richard Evans, Programme Manager for Stratified Medicine and Molecular Pathology at the MRC, said: “This research used shared clinical trial data from a large number of patients to show that simple patient characteristics can help inform the choice of therapy in diabetes; the results are likely to show real impact, and significant benefits to patients when they are implemented in patient care.
“Diabetes affects one in 17 people in the UK - research into precision or stratified approaches to this condition is crucial to getting patients the most appropriate treatment in the most efficient way, underpinned by solid evidence.”