Precision Medicine in Type 2 Diabetes

Abstract

Type 2 diabetes is a progressive disease characterised by raised blood glucose levels. Lowering of blood glucose is required to prevent symptoms of diabetes and to reduce the risk of people with type 2 diabetes developing diabetes-related complications. Metformin is the initial drug of choice to lower blood glucose for most people. However, for many people metformin eventually fails to control blood glucose and additional medication is required. At least four different types of glucose-lowering medication are recommended after metformin in current type 2 diabetes treatment guidelines. Choosing the best medication is left to the clinician and patient and is a major clinical dilemma. The degree of glucose-lowering appears to vary greatly between people for all the medication options. The same medication may appear to have a marked effect in one patient but little effect in another. Similarly, only some people develop side-effects. Despite this apparent variation it is largely unknown whether differences in treatment response and risk of side-effects can be predicted based on an individual patient’s characteristics. The aim of this thesis is to establish whether simple patient characteristics are associated with differences in treatment effect for common glucose-lowering medications. If they are, this could inform a precision medicine approach in type 2 diabetes, where medications are targeted to those people most likely to benefit.