Patients should be allowed to choose their type 2 diabetes medication: Study

A recent research suggests a fresh approach to treating type 2 diabetes that gives patients control over their own medication. The Trimaster trial is the first to provide type 2 diabetics the option to select their own medication after a sequence of three different medications. It was determined that the method may be a fresh way to pick the optimal course of action.

The Medical Research Council-funded trial, which provided participants with type 2 diabetes three routinely given medications, each for a 16-week period in turn, was conducted by researchers at the University of Exeter.

The 448 participants’ glucose levels, weight, and side effects were tracked throughout the trial by researchers, who also noted any adverse reactions. Patients got to select the medication that worked best for them at the conclusion of the trial, which has now been published in Nature Medicine. Their chosen medication not only had the fewest negative effects but also significantly reduced glucose levels.

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 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 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 into 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.”

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 per cent 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 a 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 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.