All major type 2 diabetes mellitus (T2DM) guidelines recommend sulphonylureas and thiazolidinediones as second- and third-line therapy options, respectively. However, guidance to help clinicians choose between these glucose-lowering options after metformin use is limited. A recent study published in the journal Diabetes Care, suggests that considering sex and BMI in prescribing decisions of sulphonylureas and thiazolidinediones can help improve glycaemic control and avoid damaging side-effects.
Researchers identified features associated with glycaemic response to sulphonylurea or thiazolidinedione in 22,379 patients with T2DM from the UK Clinical Practice Research Datalink. Differences in response within subgroups were validated in data from ADOPT (n=2725) and RECORD (n=2222) randomised trials of sulphonylureas and thiazolidinediones.
Females showed a greater response to thiazolidinediones but a lesser response to sulphonylureas (both P<.001). Higher BMI was associated with greater response to thiazolidinediones but a lesser response to sulphonylureas (both P<.001). In ADOPT and RECORD, nonobese males had a greater overall glycaemic response with sulphonylureas than with thiazolidinediones (P<.001). In contrast, obese females had a greater glycaemic response with thiazolidinediones than with sulphonylureas (P<.001). Thiazolidinediones associated weight gain and risk for oedema were highest in obese females.
Lead author, John Dennis, commented: “Our findings are important as they provide the first evidence that personalised medicine approach in diabetes can be based on simple patient characteristics available to any doctor, rather than expensive genetics or other technology.” Authors believe that these findings are likely to show real impact and significant benefits to patients when implemented in patient care.
