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May 2019

Simple clinical features can help personalise type 2 diabetes treatment



A new study has shown that a person’s characteristics such as weight and age at diabetes diagnosis provide a simple way to select the diabetes drug that is likely to be best for them.

The new research from the University of Exeter Medical School and published in The Lancet Diabetes and Endocrinology, shows that using these characteristics is more simple and effective than allocating patients with diabetes into five subgroups, a model proposed by Swedish researchers last year. Instead, the new study shows that using simple clinical features is a better way to guide treatment and identify people at increased risk of complications including kidney disease.

Dr John Dennis, of the University of Exeter Medical School, lead author of the study, said: ‘It’s recognised that not everyone with type 2 diabetes should be treated the same, yet there is currently no way to tell which medication is likely to be the best for a particular person.

‘Our research shows that really simple clinical features such as age at diagnosis, sex, and kidney function provide a very effective and practical way to identify the best tablet for a particular person and to identify people at high risk of developing complications. Crucially, this approach does not mean reclassifying people into discrete subtypes of diabetes. Instead, we were able to use a person’s exact characteristics to provide more precise information to guide treatment.’

The new study, supported by the Medical Research Council, looked at data from more than 8,500 participants in two independent clinical trials.

Professor Andrew Hattersley, of the University of Exeter Medical School, who oversaw the research, said: ‘Managing people with type 2 diabetes is complex, and more evidence-based approaches are urgently required. Our research tested whether simple clinical characteristics are useful to help clinicians manage their patients. We found that using simple measurements available freely in clinic can lead to improved prediction of patient outcomes.’

Dr Emily Burns, Head of Research Communications at Diabetes UK, said: ‘Type 2 diabetes is a complex condition and we need to move beyond a one-size-fits-all approach to treatment. This research suggests that healthcare professionals can use simple measurements readily available to them now, including BMI and age of diagnosis, to determine the best treatments for each individual person. This could also potentially help them to work out who is most at risk of serious diabetes complications, so they can intervene early.

‘Personalising medicine for people with type 2 diabetes is so important, and this research – expanding our understanding of how best to choose the right treatment for each person – takes us one step closer.’

Dennis JM, Lancet Diab Endocrinol 29 April 2019

http://www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30087-7/fulltext