A prediction tool to help guide GPs when choosing treatments for type 2 diabetes could improve blood glucose control and the need to switch drugs, researchers have found.
UK researchers developed the model based on routinely collected clinical information to assess the best treatment option after metformin.
It calculates which of five classes of medicines – dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 receptor (GLP-1R) agonists, sulfonylureas, sodium–glucose co-transporter-2 (SGLT2) inhibitors, and thiazolidinediones – would be most effective in a particular patient.
Testing of the tool, which was developed with UK GP patient records in various datasets, showed its suggested drug treatment options could lead to reductions in blood glucose levels (HbA1c) at one year of roughly 5mmol/mol.
Writing in The Lancet, the team led by Exeter University reported that since 2019 in England, only 17.8% of treatments initiated for type 2 diabetes would have been the best option as predicted by the model.
It uses nine predictive factors; age, duration of diabetes, sex, baseline HbA1c, BMI, estimated glomerular filtration rate, HDL cholesterol, total cholesterol and alanine aminotransferase to predict which drug class will be most effective.
The improved glucose control associated with the optimal drug choice, could also lead to double the length of time before patients need to start taking additional treatments, the researchers found.
Treatment as directed by the tool was associated with a 38% reduced risk of glycaemic failure over a five-year period.
Analysis suggested its use could also lead to lower risks of developing complications such as heart attacks, strokes and kidney disease.
The prediction tool is currently being tested in clinical practice in 22,500 patients with type 2 diabetes across Scotland, which will inform rollout across the UK, the researchers said.
Around three million people are prescribed glucose-lowering drugs in England with NICE recommending metformin as standard with an SGLT2 inhibitor in people at high cardiovascular risk.
Other options, if needed for blood glucose control, should be used, in stepwise manner checking for tolerability and effectiveness, taking into account patient preference as well as factors such as other co-morbidities and weight.
Study lead Dr John Dennis, associate professor of health data science at the University of Exeter, said: ‘We have developed a completely new personalised approach for diabetes treatment, that could benefit everyone with type 2 diabetes in the UK and worldwide.
‘For the first time, our model allows people living with type 2 diabetes to quickly identify the best treatment to manage their blood sugar levels, helping reduce their risk of diabetes complications.
‘This offers a major advance on the current approach to choosing diabetes medications.’
Co-author Professor Andrew Hattersley, professor of molecular medicine also at the University of Exeter, added: ‘Critically, our model can be implemented in clinical care immediately and at no additional cost.
‘We hope that we can roll out the model quickly to make it available to help people with type 2 diabetes in the UK and across the world.’
Dr Elizabeth Robertson, director of research and clinical at Diabetes UK, who part funded the work along with the Medical Research Council and National Institute for Health Research, said the tool could help countless people with type 2 diabetes to get their blood sugars levels into a safe range.
‘If shown to be effective in practice and widely adopted by health services in the UK and globally, this tool could mark the most significant advance in type 2 diabetes care in more than a decade, improving health outcomes for millions.’
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That would be a very difficult thing to know what the blood glucose of a patient would have been if they had been prescribed each of the 4 other medications for a year.
So, at 17%, does the model get it wrong 82% of the time, or the patient-GP decision is wrong 82% of the time?
Some research is meaningful, others are about justifying the existence of researchers. I’ll let others decide which this is.