Experts Call for More Individualized Drug Therapy

Diabetes experts recently issued a consensus statement in the Journal of Clinical Endocrinology and Metabolism calling for more individualized treatment approaches for the nearly 250 million people worldwide who have Type 2 diabetes. Currently, only about half of people being treated for this condition reach their blood glucose goals.


Prompted by recent scientific advances that have given researchers a better understanding of various genetic factors that play a role in Type 2 diabetes, the experts suggested a number of approaches for determining the most effective type of treatment for each individual. Recommendations include expanding research to explain why people have such different responses to different diabetes treatments, reexamining existing diabetes data in hopes of extracting new insights, and developing new technologies to identify the various diabetes subtypes.

According to statement coauthor Robert Smith, MD, “Recent advances in genetics such as the identification of the responsible genes for several forms of Maturity Onset Diabetes of the Young (MODY)…have established precedents linking specific drug therapies to defined subtypes of patients….As more genetic factors related to type 2 diabetes are identified and as our understanding of the progression of the disease evolves, we can expect to gain precision in identifying the best drug choices for individual patients and to more effectively halt the progression of diabetes.”

For more information, read the article “Considering Diabetes Treatment, Experts Say One Size Does Not Fit All” or see the statement’s abstract in the Journal of Clinical Endocrinology and Metabolism.

Is your current diabetes management plan working for you? Or do you think that your blood glucose would be better controlled with a more personalized treatment regimen? Let us know with a comment below!

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  • Donna

    Thank goodness this is being said!! It’s like the story of “The Emperor with no clothes.” As a 15-year Type II diabetic with terrible control, I was always made to feel like my high A1c’s were my fault — “fewer calories in…” said my endocrinologist. Nothing I did really made any difference, unless my diet was limited to protein and green beans, which gets old quickly.

    A month ago, I went to a prominent university hospital’s endocrine department, and in 1 month, my A1c went from 9.8 to 7.6. Actos and Victoza (similar to Byetta) were added to my old regime of Lantus, Humalog (with sliding-scale dosing, not carb counting)and metformin. I am more motivated than any other time since I was diagnosed at 33 — how I eat and move finally impact my glucose levels. I am taking much less insulin now, and actually seeing my weight drop.

    I used to troll the internet and medical journals to see how many people were actually compliant and successful with their diabetes management. I couldn’t find much information, but I knew that I was not the only one. Thank you for this information!

  • Judy

    yes,we don’t all fit into the same slot all though I feel that is the kind of treatment I have recevied.I’m not insensetive to the fact that Dr’s are exteremly busy but I’m beginning to feel like a piece of cattle rushed through the shoot.And don’t mention having an allergic reaction,there is no such thing.

  • tmana

    Finally, the medicos are suggesting the same thing I’ve been saying for years.

    There are five different classes of oral antidiabetic medications, each of which works differently on the body. There are three or four different diet philosophies, ranging from ADA to low/no carb to whole/raw food to DASH-sodium, each of whose success varies on the individual. My hypothesis is that the “Type 2 Diabetes” umbrella includes several distinct pathologies, the symptoms of which may include impaired glucose tolerance, adipokine-mediated insulin resistance (possibly related to metabolic syndrome), other-source insulin resistance, high serum insulin levels, low serum insulin levels, altered insulin folding sequence, and/or altered insulin chemistry.
    Even without the ability to analyze a gene scan for specific genotypes and phenotypes, one can use the spectrum of existing diagnostics to uncover a more specific presentation and tailor therapy appropriately. For example, a person who exibits hyperglycemia subsequent to an Oral Glucose Tolerance Test (OGTT) but who also has high serum insulin levels is likely insulin-resistant, and should (in theory) respond better to an insulin sensitizer than to an insulin secretagogue. A person who “passes” the OGTT but who exhibits postprandial hyperglycemia subsequent to a mixed-carbohydrate meal may have a failed or failing second-phase insulin response and may need to limit the amount of complex carbohydrates consumed at a meal, or may need a different class of drug. A person with low serum insulin and an out-of-range c-peptide test (but no GAD antibodies) may have been undiagnosed long enough, and lost so much beta cell function, that an exogenous insulin regime needs to be started at the point of diagnosis.
    Now, I Am Not A Physician and my hypothesis is general in the extreme, but I believe it is a concept that could be used to better tailor treatment to the individual than the “one size fits none” approach that is currently being touted.

  • pat

    now we are getting some where. We are different in the diabetes field.