Precision medicine on horizon for type 2 diabetes

Today, there are 12 classes of drugs that have been proven in large clinical trials internationally to manage type 2 diabetes. In Aotearoa New Zealand, half of these medications are funded, including the recently funded vildagliptin. The problem is, medications work very differently in different people, and at the moment doctors can only figure out the best match for an individual patient through trial and error.

Associate Professor Rinki Murphy, endocrinologist and researcher at the University of Auckland’s Faculty of Medical and Health Sciences, says a ‘precision medicine’ approach to managing type 2 diabetes, which affects over 200,000 people in New Zealand, would have many benefits.

“Knowing who responds best to each type of diabetes drug would help patients to get more effective medication earlier in their treatment, with fewer negative side effects, and improved health outcomes,” she says.

“The savings made from removing redundant drugs from people’s ever-growing medication cocktails could enable us to fund a greater selection of diabetes medications, if they could be used in a stratified and rational way.”

Dr Murphy is leading a pioneering study to identify which personal factors predict people’s response to two different diabetes drugs: vildagliptin and pioglitazone. The study team of doctors and nurses are looking to recruit 300 people aged 18-80 years with type 2 diabetes who are currently treated with metformin and/or sulfonylurea medications, but still require extra diabetes medication.

Funded by the Health Research Council and University-based Maurice Wilkins Centre, the study is running in Auckland, Kaitaia, Tairāwhiti Gisborne and Waikato.

Participants will be asked to donate an initial blood sample to check for blood biomarkers including genetics, insulin and lipids (fats), and undergo a general medical assessment. They will then receive either pioglitazone or vildagliptin for four months each, in random order. At the end of the eight months, each participant will receive a summary of their own responses, and personal preference to the two medications, so they can decide with their usual doctor on their long-term treatment.

“We are trying to understand whether the glucose-lowering response to these two contrasting medications differs by ethnicity, age, gender, body size, lipids, and genetics,” says Dr Murphy.

“We are particularly interested in whether the response is different among people of Māori and Pacific ancestry, because they are not represented in the international clinical trials evaluating these diabetes medications, and it is possible that due to unique genetics, there may be biological reasons for different metabolism and effectiveness of these drugs among people of different ethnicities.”

Researchers hope that the results of this study, combined with future studies looking at the other diabetes medications, will bring precision medicine to type 2 diabetes in the near future.

People interested in joining the study can email t2dmed@auckland.ac.nz or find out more information on the study page.