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Two simple factors could determine your response to additional diabetes treatment

A recent study in the UK suggests that patients’ sex and BMI can have a profound effect on their response to certain second-line diabetes treatment.

Personalized medicine is a medical model that stratifies medical decisions based on individual patient characteristics. The term often conjures up images of extensive biological assays and cutting-edge genetic testing. Yet not all guidelines for personalized medicine need to rely on advanced technology, according to a recent study on diabetes.

Most patients with type 2 diabetes are first prescribed metformin. However, when additional medications are required for the management of diabetes, few guidelines are available for physicians to select the right second-line drug. Decisions are often based on averages from large-scale studies, with an average glycemic response (i.e. the effect of food intake on blood sugar levels) and overall side effects being the metrics of concern.

According to a report in the BMJ, a recent study in the UK aimed to identify patient characteristics that could assist physician decision making within this context. The full paper was published in Diabetes Care. The study analyzed data from 22,379 diabetic patients who had been treated with sulfonylurea or thiazolidinediones (TZDs) for a period of at least five years. Data was extracted from both clinical trials and general practice.

The researchers found that sex and body mass index (BMI) had a significant effect on patients’ response to these medications.  Non-obese men had improved glycemic responses when taking sulfonylurea compared to TZDs. Conversely, obese women were found to have superior glycemic responses when taking TZDs compared to sulfonylureas. Side effects were also stratified by sex and BMI, with obese women being at greatest risk of weight gain and fluid build up in extremities when prescribed TZDs. However, sex and BMI were not found to increase the risk of low blood sugar levels under these medications.

The study authors suggest that these two factors, sex and BMI, can be used to select appropriate second-line diabetes treatment resulting in improved glycemic responses. These simple criteria, coming at no additional cost, should be a welcome addition to treatment guidelines of burdened public health systems.

Written by Agustin Dominguez Iino, BSc


  1. Dennis JM, Henley WE et al. Sex and BMI Alter the Benefits and Risks of Sulfonylureas and Thiazolidinediones in Type 2 Diabetes: A Framework for Evaluating Stratification Using Routine Clinical and Individual Trial Data. Diabetes Care. 2018 Sep;41(9):1844-1853. doi: 10.2337/dc18-0344. Epub 2018 Aug 2.
  2. Wise J. Diabetes: simple patient characteristics should help inform choice of second line drug, study finds. BMJ. 2018; 362 doi: (Published 03 August 2018)


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