A New Approach to Treating Diabetes

A new study presents a novel approach to managing type 2 diabetes – letting patients be in charge of their own medication.

A new large-scale study known as the Trimaster study offers a revolutionary approach to treating type 2 diabetes by putting patients in charge of their own medication. This is the first study of its kind that allows individuals with type 2 diabetes to select their own medication after trying three different drugs in succession. The results of the study suggest that this approach could be a new way of identifying the most effective treatment for patients.

The study, which was funded by the Medical Research Council and led by researchers at the University of Exeter, involved giving 448 patients with type 2 diabetes three commonly prescribed drugs, each for a 16-week period in turn. The researchers monitored the effect of each drug on the patient’s glucose levels and weight and recorded any side effects. At the end of the study, which was recently published in Nature Medicine, patients were able to choose the drug that worked best for them. Their chosen drug not only effectively lowered glucose levels but also resulted in fewer side effects.

Personalizing Diabetes Care

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 a 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 the best blood sugar control – even before they knew those results.”

Participant Tim Keehner, from North Devon, was diagnosed with type 2 diabetes 15 years ago. The marketing expert was enrolled in the study because his blood sugar was running too high.

“I was given three drugs. The first two didn’t work for me at all – in fact, one of them made me feel even worse. Thankfully, from the first moment I took the third drug, I felt different – I had more energy, and I knew it was the right drug for me. I’m still on it today and I’m able to engage in all the sports I love – it’s fantastic.”

Addressing Diabetes at Scale

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 percent 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.

Diabetes consultant Professor Andrew Hattersley CBE, of the University of Exeter, who oversaw the research, said: “This is the first study in which the same patient has tried three different types of glucose-lowering drug, enabling them to directly compare them and then choose which one is best for them. We’ve shown that going with the patients’ choice results in better glucose control and fewer side effects than any other approach. When it’s not clear which drug is best to use, then patients should try it before they choose. Surprisingly, that approach has never been tried before.”

The three drugs given to patients in the trial were sitagliptin, canagliflozin, and pioglitazone.

Reference: “Patient preference for second- and third-line therapies in type 2 diabetes: a prespecified secondary endpoint of the TriMaster study” by Beverley M. Shields, Catherine D. Angwin, Maggie H. Shepherd, Nicky Britten, Angus G. Jones, Naveed Sattar, Rury Holman, Ewan R. Pearson and Andrew T. Hattersley, 7 December 2022, Nature Medicine.
DOI: 10.1038/s41591-022-02121-6

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