No abstract

Diabetes is fast gaining the status of a potential epidemic in India with more than 62 million diabetic individuals currently diagnosed with the disease. There are atleast 10 different drug classes for the treatment of Type 2 diabetes mellitus (T2DM) but metformin is recommended as the initial medication for treatment of T2DM. Inter-individual variability in response and few clinical or biomarker predictors of response reduces its optimal use. Personalized medicine promises a path for individually optimized treatment, but realizing this promise will require a more comprehensive characterization of disease and drug response. As per American Medical Association, pharmacogenomics is the study of genetic variations that influence individual response to drugs. Knowing whether a patient carries any of these genetic variations can help prescribers individualize drug therapy, decrease the chance for adverse drug events, and increase the effectiveness of drugs. There are variety of genes controlling metformin transport in the body, for eg-SLC22A1, SLC22A2, SLC22A3, SLC22A4 etc. The purpose of this review article is to explain in brief pharmacogenomics of metformin and its application and practical hurdles in its translation.

Background: Diabetes mellitus is a progressive disease characterised by declining β-cell function. Cornerstone of effective management of T2DM is maintaining strict glycaemic control through agency of various oral hypo-glycaemic agents (OHAs). Metformin (a biguanide) currently forms the preferred treatment in newly diagnosed patients of T2DM. Vildagliptin is a potent, orally administered, competitive and reversible inhibitor of DPP-4, which was launched in 2006 and is now approved in more than 70 countries worldwide.Methods: The study was a single blinded study conducted in a district level tertiary care hospital attached to a medical teaching institute. Newly diagnosed patients were screened and randomised in two groups. Group 1 received metformin (500 mg) twice daily and group 2 received vildagliptin (50 mg) twice daily. FPG, PPPG, HbA1c and Weight were assessed on week 0 and week 12.Results: At the end of 12 weeks, ∆FPG was 39.33±4.72mg/dL and 37.84±6.58mg/dL with metformin and vildagliptin respectively. ∆PPPG was 73.88±13.80 mg/dL and 65.08±13.00mg/dL with metformin and vildagliptin. ∆HbA1c was 1.12±0.46 and 0.95±0.32 with metformin and vildagliptin. ∆Weight was 1.02±0.90 Kg with metformin and 0.69±1.33 Kg.Conclusions: Vildagliptin offers an alternative mode of therapy for newly diagnosed, obese patients of type 2 DM, especially those with impaired fasting plasma glucose.