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How amenable is type 2 diabetes treatment for precision diabetology? A meta-regression of glycaemic control data from

Oliver Kuss1,2,3, Marie Elisabeth Opitz4, Lea Verena Brandstetter4

  • 1Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany. oliver.kuss@ddz.de.

Diabetologia
|June 20, 2023
PubMed
Abstract

Insights

Precision medicine for type 2 diabetes shows modest potential for improving glycemic control. While some treatments increase outcome variability, GLP-1 receptor agonists may offer personalized benefits for specific patient groups.

Area of Science:

  • Endocrinology
  • Pharmacogenomics
  • Clinical Trial Analysis

Background:

  • Precision medicine requires treatment heterogeneity and identifiable predictors for efficacy.
  • Meta-regression of placebo-controlled trials assesses outcome variability and predictors.
  • Type 2 diabetes treatment variability was analyzed using this approach.

Purpose of the Study:

  • To evaluate the prerequisites for precision medicine in type 2 diabetes treatment.
  • To assess the variability of glycemic control (HbA1c) and its predictors.
  • To determine the potential for personalized treatment strategies in type 2 diabetes.

Main Methods:

  • Meta-regression analysis of 174 placebo-controlled randomized trials.
  • Included 86,940 participants with type 2 diabetes.
  • Analyzed variability in HbA1c and identified predictors, including drug class.

Main Results:

  • A small increase in HbA1c variability was observed with active treatments (verum arms).
  • Drug class emerged as a predictor, with GLP-1 receptor agonists showing the largest variability differences.
  • The adjusted difference in log(SD) for verum vs. placebo arms was 0.037 (95% CI: 0.004, 0.069).

Conclusions:

  • The potential for precision medicine in type 2 diabetes glycemic control is limited.
  • GLP-1 receptor agonists may influence HbA1c variability, particularly in individuals with poor control.
  • Further validation with diverse clinical outcomes and study designs is recommended.
Keywords:
Dipeptidyl peptidase-4 inhibitorsGlucagon-like peptide 1HbA1cMeta-regressionPrecision medicineSodium–glucose transporter 2 inhibitors, Type 2 diabetes mellitus

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