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Factoring in gender and BMI can aid prescribing decisions for type 2 diabetes

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Clinicians can match type 2 diabetes patients to the right drug to improve blood glucose control by factoring in characteristics like body mass index and sex into prescribing decisions, say researchers.

They said their findings could dramatically improve benefits of drugs and reduce the risk of potentially harmful side-effects such as weight gain and hypoglycaemia, at no additional cost.

“This simple personalised approach could be implemented immediately within the NHS”

John Dennis

Currently, the Exeter University researchers noted that clinicians had to make prescribing decisions on additional drug options after metformin based on limited available guidance.

A previous study involving the same research team revealed great regional variations across the UK in the prescribing of these additional drugs, such as sulfonylureas and thiazolidinediones.

Their new study, which has been published in the journal Diabetes Care, provides a more evidence-based approach to the prescribing of drugs after metformin, they said.

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.

Based on a participant’s gender and BMI, they found important differences in the effect of sulfonylureas and thiazolidinediones in lowering blood glucose levels and on the risk of side effects.

“The results are likely to show real impact, and significant benefits to patients”

Richard Evans

For example, obese females were far more likely to have good blood glucose control on thiazolidinediones than sulfonylureas.

Meanwhile, non-obese males had the opposite result and were far more likely to have good blood glucose control on sulfonylureas than thiazolidinediones.

The researchers suggested their findings were potentially applicable to many of the 3.5 million plus people currently diagnosed with type 2 diabetes in the UK.

Lead study author John Dennis, from 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.

“This simple personalised approach could be implemented immediately within the NHS without any additional cost,” said Mr Dennis.

He added: “The study is also a powerful demonstration of how the sharing of patient data can meaningfully benefit patients – in this case helping to make sure individual patients get the best drug for them.”

“At the moment, clinicians are in the difficult position of making decisions on type 2 diabetes based on very little evidence”

Andrew Hattersley

Senior study author Professor Andrew Hattersley, a diabetes consultant at Royal Devon and Exeter NHS Foundation Trust, said: “At the moment, clinicians are in the difficult position of making decisions that impact on health in type 2 diabetes based on very little evidence.

“Now, we can create clear guidelines to enable much more informed conversations about what these treatments will mean for people, in order to get better health outcomes and avoid harmful side effects,” he said.

The study was funded by the Medical Research Council (MRC). Dr Richard Evans, programme manager for stratified medicine and molecular pathology at the MRC,commented on the findings.

He 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,” he added.

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