Sex and body mass index (BMI) should be used to guide choice of second-line treatment for type 2 diabetes mellitus, a UK study has found
The Medical Research Council-funded study found that simple patient characteristics, such as BMI, can alter the benefits and risks, in terms of differing glycaemic response and side effects, of type 2 diabetes mellitus therapy with sulfonylureas and thiazolidinediones.
The study looked at 22,379 patients starting sulfonylurea or thiazolidinedione therapy in the UK Clinical Practice Research Datalink (CPRD) to identify features associated with increased one-year HbA1c blood glucose fall with one therapy class and reduced fall with the second. The researchers then used individual randomised trial data to assess whether pre-specified patient subgroups, defined by differential clinical factors, showed different five-year glycaemic responses and side effects.
In the CPRD group it was found that, compared with males, females had a greater response with thiazolidinediones but a lesser response with sulfonylureas. A higher BMI was associated with greater response with thiazolidinediones but a lesser response with sulfonylureas.
The absolute risk of weight gain and oedema with thiaziolidinediones was highest in the obese female subgroup.
In the trial group, over five years the greater overall glycaemic response with sulfonylureas was seen in non-obese males. In contrast, there was a greater overall glycaemic response for obese females with thiazolidinediones over sulfonylureas.
The researchers concluded that putting patients into subgroups — male, female, BMI >30kg/mÂ² and BMI ≤30kg/mÂ² — could help inform discussions around the choice of second-line therapies for individual patients.
“Our findings will allow for much more informed discussions of the benefits and risks of these therapies than the present ‘one size fits all’ approach,” concluded the researchers, but they added that further studies were required to fully evaluate the association between glycaemic response and the risk of common side effects for these therapies.
 Dennis J, Henley W, Weedon M et al. Sex and BMI alter the benefits and risk of sulfonylureas and thiazolidinediones in type 2 diabetes: a framework for evaluating stratification using routine clinical and individual trial data. Diabetes Care 2018;dc180344. doi: 10.2337/dc18-0344