Let the patient choose their type 2 diabetes medication, says research study

The Trimaster study, supported by the University of Dundee, allows participants to choose from one of three commonly prescribed drugs to treat their condition, upon completion of a trial period of each.

During the study period, researchers monitored the effect of each drug on the 448 patients’ glucose levels and weight and recorded the side effects.  At the end of the study, patients got to choose the drug that worked best for them. Their chosen drug not only lowered glucose most effectively, but also resulted in less side effects.

The findings of the study, funded by the Medical Research Council and led by researchers at the University of Exeter, has been published today in Nature Medicine.

Ewan Pearson, Professor of Diabetic Medicine at Dundee, said, “People with type 2 diabetes can be very different from each other.

“For example, they may differ in age, body weight or kidney function, yet the current approaches to treatment with medication do not take this into account. However, we have shown that how people respond to different diabetes treatments does vary, with some people having a much better response to one drug than another. One simple approach to find the best drug is for patients to try each drug in turn and see what they prefer.”

Type 2 diabetes affects more than four million people in the UK and is a major cause of illness and death. It also accounts for 10 per cent of NHS expenditure. The problems associated with diabetes can be greatly reduced if the blood sugar levels are lowered. A number of different drugs work to reduce blood sugar, and while overall they are similarly effective, individual patients will vary in terms of how much the drug lowers their blood sugar and the side effects they have. Choosing the right drug for a patient is difficult.

Over the course of the study, patients were able to trial three medications - sitagliptin, canagliflozin, and pioglitazone – before settling on one which they felt worked best for them.

Lead author Dr Beverley Shields of the University of Exeter, said, “Getting the right treatment for diabetes is fundamental to getting the best outcomes, and maintaining good quality of life.

“Our study is the first to invite people with type 2 diabetes to try common drugs in succession, to see which one works best for them.  Interestingly, we found that the treatment people chose was usually the one which gave them best blood sugar control – even before they knew those results.”