Doctors should use gender and body mass to personalise diabetes care, study says
Simple factors such as gender and body mass can help doctors to personalise care for patients with type 2 diabetes and avoid harmful side effects, according to a study.
Clinicians can match the right drug to patients by taking into account BMI and sex, which can improve blood sugar control and avoid side-effects, such as weight gain and hypoglycaemia.
Researchers at the University of Exeter said the findings would come at no additional cost to the NHS.
Metformin is the first-line of drug treatment in type 2 diabetes but many patients will eventually need additional drugs on top of metformin to lower their blood sugar levels.
Currently, clinicians have to make prescribing decisions on these additional drug options based on limited available guidance.
Recent research involving the Exeter team has revealed there is great regional variation across the UK in the prescribing of these additional drugs.
The new study provided a starting point for a more evidence-based approach to the prescribing of drugs after metformin.
Based on a patients’ gender and BMI, they 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.
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 were able to show 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.
PhD student John Dennis, who led the study, 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 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.”
Professor Andrew Hattersley, professor of molecular medicine and a consultant in diabetes, 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.”
The study, Sex And BMI Alter The Benefits And Risks Of Sulfonylureas And Thiazolidinediones In Type 2 Diabetes: A Framework For Evaluating Stratification Using Routine Clinical And Individual Trial Data, is published in journal Diabetes Care.