A review of treatment response in type 2 diabetes: assessing the role of patient heterogeneity

Abstract

The response to treatment for type 2 diabetes typically varies among individuals within a study population. This variation is known as heterogeneity of treatment response. We conducted a comprehensive literature review to identify factors that account for heterogeneity of treatment response in patients treated for type 2 diabetes. Three databases (PubMed, EMBASE and Cochrane Library) were searched for articles published in the last 10 years describing investigations of factors associated with treatment response and outcomes among people with type 2 diabetes receiving pharmacological treatment. Of the 43 articles extracted and summarized, 35 (81%) discussed clinical factors, 31 (72%) described sociodemographic factors and 17 (40%) reported on comorbidity or behavioural factors. Clinical factors identified included baseline glycated hemoglobin A1c or fasting plasma glucose (FPG) levels, insulin response or sensitivity, C-peptide, body composition, adipose tissue proteins, lipid profile, plasma albumin levels and duration of disease or insulin treatment. Other factors identified included age, sex, race, socioeconomic status and comorbidities. This review identified the following research gaps: use of multiple definitions for response, few patient-reported measures and lack of evidence regarding whether factors were associated with treatment response for only specific medications or across pharmacological therapies. Furthermore, identification of factors associated with type 2 diabetes treatment response was generally a secondary objective in the research reviewed. Understanding which patient subgroups are more likely to respond to treatment and identifying factors associated with response may result in targeted treatment decisions and alter the interpretation of efficacy or effectiveness of results. In conclusion, accounting for these factors in clinical trials and when making clinical treatment decisions may improve therapy selection and individual patient outcomes.

Association between beta cell function and future glycemic control in patients with type 2 diabetes

“…Multivariate logistic regression analysis showed that, in addition to postprandial CPR index, male sex, shorter duration of diabetes, absence of family history of diabetes, lower BMI, lower HbA1c, administration of a lower number of oral hypoglycemic agents (OHA) and no insulin use before admission were significantly related to good glycemic control, which is largely in line with the results of previous studies [14,15]. Accordingly, these results indicate that the predictive value of postprandial CPR index is relatively small.…”

“…All data are expressed as mean ± SD, and significance levels for all tests were α = 0.05 in those trials. Although several studies have examined the correlation between CPR level and treatment outcome [14,15], the correlation remains to be established and there are few available data, especially in the Japanese population. The present study showed an association between baseline CPR and future glycemic control in the Japanese population, using our cohort with a relatively large sample size and long duration of follow-up.…”

Type 2 diabetes: a cohort study of treatment, ethnic and social group influences on glycated haemoglobin

“…Poor HbA1c control in African Americans has also been reported in the USA, though our study found no such disparity in black African/Caribbean people 14 16 25 26…”

Elucidating sex and gender differences in diabetes: a necessary step toward personalized medicine

“…In addition, the global prevalence of obesity is higher in women than in men (Kelly et al, 2008). Finally, there is a sex specific response to anti-diabetic drugs in patients with type 2 diabetes (Cantrell et al, 2010).…”