Simple factors that can avoid harmful side effects in type 2 diabetes

August 2, 2018, University of Exeter
Credit: CC0 Public Domain

Clinicians can match people with type 2 diabetes to the right drug for them to improve control of blood sugar and help avoid damaging side-effects, simply by factoring in simple characteristics such as sex and BMI into prescribing decisions, new research has shown.

The study, by the University of Exeter Medical School, 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 to the NHS.

Metformin is the first line of drug treatment in type 2 , but many 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, funded by the Medical Research Council and 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 patients' gender and BMI, the authors found important differences in the likely success of the commonly-prescribed drugs sulfonylureas and thiazolidinediones in lowering , 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.

John Dennis, of the University of Exeter Medical School, was lead author on the study. He 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 for them."

Professor Andrew Hattersley, a Consultant in Diabetes at the Royal Devon and Exeter Hospital and Research Professor at the University of Exeter Medical School 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."

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 afflicts 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."

The full paper, '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 Diabetes Care.

Explore further: Switching to certain antidiabetic drugs linked to increased risk of major complications

Related Stories

Switching to certain antidiabetic drugs linked to increased risk of major complications

July 18, 2018
For people with type 2 diabetes, switching to sulfonylurea drugs to control blood sugar levels is associated with an increased risk of complications compared with staying on the drug metformin, finds a study in The BMJ today.

ACP recommends metformin to treat type 2 diabetes based on CE analysis of oral medications

February 6, 2012
The American College of Physicians (ACP) recommends that clinicians add metformin as the initial drug treatment for most patients with type 2 diabetes when lifestyle modifications such as diet, exercise, and weight loss have ...

Researchers change clinical practice for infants with diabetes

June 8, 2018
It is not necessary to treat diabetic infants with insulin syringes. This will be new clinical practice after a recent study, now published in Lancet Diabetes & Endocrinology in which researchers from Bergen and Exeter tested ...

Common diabetes drugs may carry risk, study suggests

September 26, 2013
(HealthDay)—Diabetes patients who take drugs called sulfonylureas as an initial therapy have a higher risk of death than those who take the diabetes drug metformin, a new study says.

First-line metformin use for DM up; sulfonylurea use down

November 19, 2017
(HealthDay)—Among patients with type 2 diabetes initiating antidiabetes drugs (ADDs), first-line use of metformin has increased since 2005, while sulfonylureas have remained the most popular second-line agent, according ...

Diabetes drug, metformin, lowers risk of heart disease deaths better than sulfonylureas

April 18, 2016
A new analysis of 204 studies involving more than 1.4 million people suggests that metformin, the most frequently prescribed stand-alone drug for type 2 diabetes, reduces the relative risk of a patient dying from heart disease ...

Recommended for you

Researchers have found that incidence of heart failure was around two-fold higher in people with diabetes

December 11, 2018
Researchers have found that incidence of heart failure was around two-fold higher in people with diabetes.

Millions of low-risk people with diabetes may be testing their blood sugar too often

December 10, 2018
For people with Type 2 diabetes, the task of testing their blood sugar with a fingertip prick and a drop of blood on a special strip of paper becomes part of everyday life.

Very low calorie diets trialled by NHS to tackle diabetes

December 7, 2018
Hundreds of thousands of people will receive NHS help to battle obesity and type 2 diabetes under radical action set out by Simon Stevens, Chief Executive of NHS England.

New therapeutic avenue for type 2 diabetes

December 6, 2018
Restoring the action of insulin is one of the keys to fighting type 2 diabetes. Researchers from Inserm led by Dominique Langin at the Institute of Cardiovascular and Metabolic Diseases (Inserm/Université de Toulouse) are ...

Subtype of immune B cells can delay type 1 diabetes onset in mice

December 6, 2018
A team of researchers at Baylor College of Medicine and the University of Michigan Medical School reports today in the JCI Insight that a subset of immune B cells, known as CD19+IgM+ B cells, can delay the onset of type 1 ...

Is the pancreas regeneration debate settled? An original theory renewed

December 5, 2018
A contentious debate among diabetes researchers has surrounded the regeneration of pancreatic insulin-producing cells: not if these cells regenerate, but rather how.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.