Researchers now have the answer
Lund University
Metformin is the first-line drug that can lower blood sugar levels in type 2 diabetes patients. One third of patients do not respond to metformin treatment and 5 per cent experience serious side effects, which is the reason many choose to stop medicating.
Researchers at Lund University in Sweden have now identified
biomarkers that can show in advance how the patient will respond to metformin
treatment via a simple blood test.
"Our
study constitutes an important step towards the goal of personalised care for
diabetes patients because it can contribute to ensuring that the right person
receives the right care as soon as there is a diagnosis," says Charlotte
Ling, professor of epigenetics at Lund University, who led the study.
When diet and exercise are not enough to regulate blood sugar, metformin is the first drug introduced to treat type 2 diabetes, according to international guidelines. If it does not have the intended effect in the form of lowered blood sugar levels, or if the patient experiences serious side effects, patients then go on to trial other drugs.
"If
it takes a long time for the patient to receive the correct treatment, there is
a risk of complications due to the elevated blood sugar levels. Approximately
30 per cent of all patients with type 2 diabetes do not respond to metformin
and should be given another drug right from the start. For this reason, it is
important to be able to identify these patients upon diagnosis," says
Charlotte Ling.
One
third of patients experience side effects usually in the form of
gastrointestinal difficulties such as nausea, stomach pain and diarrhea. Five
per cent stop taking the medicine due to severe side effects.
The
study is the first pharmacoepigenetic study in diabetes, i.e. that researchers
have studied how epigenetic factors, such as DNA methylation (see fact box),
can be used as biomarkers to predict the effect of a drug.
"To
a certain extent, pharmacoepigenetics has been used within cancer care to
predict how a person will respond to a treatment, however, it has never been
done in diabetes care before," says Charlotte Ling.
Researchers
in the study have looked at epigenetic modifications, so-called DNA
methylations, in blood from individuals diagnosed with diabetes before they
started taking metformin. In a follow-up a year later, the researchers could
see which patients had benefited from the treatment (with resulting lowered
blood sugar levels) and whether or not they had suffered from side effects.
"By
compiling the responses, we have found biomarkers that can identify already at
diagnosis of diabetes which patients will benefit from and tolerate metformin,
which will advance personalised therapy in type 2 diabetes," says the
study's first author Sonia García-Calzón.
The
study was conducted on 363 participants from three different patient cohorts
(All New Diabetics in Skåne, All New Diabetics in Uppsala and Optimed from
Latvia). As a next step, the researchers are planning for a new clinical study
in which they will repeat the study with a larger patient group -- 1000
patients will be invited to participate from all around the world.