treatment of diabetes should be directed toward hetogrogenictic type

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Using Genotypes to Individualize Diabetes Treatment

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A new consensus report outlines current knowledge of the heterogeneity of

Type 2 diabetes as well as areas that need to be further explored, based on

phenotypes

and genotypes. Experts also provide recommendations to bring health care

professionals closer to the goal of individualizing therapy.

" Although Type 2 diabetes is considered to be heterogeneous with regard to

its clinical presentation, features and pathogenesis, including

pathophysiology

and underlying genetic risk factors, patients are generally treated

similarly, independent of the underlying differences that might affect

therapeutic

response. Further insight into the heterogeneity of the Type 2 diabetes

patient population might help explain and, ultimately, reduce the high rate

of

treatment failure, " the experts wrote.

Current knowledge is based on head-to-head comparison studies, crude or

deficient baseline phenotyping and genotyping, and inadequate subset

analyses, rendering

the current models of treatment for Type 2 diabetes nonspecific, according

to the report. To date, understanding " has not yet reached a point at which

it can guide individualized therapy decisions, " the experts wrote. However,

progress is apparent.

" Recent advances in genetics, such as the identification of the responsible

genes for several forms of Maturity Onset Diabetes of the Young (MODY), now

referred to as monogenic diabetes, have established precedents linking

specific drug therapies to defined subtypes of diabetes patients, " J.

,

MD

,

of Brown University, Providence, RI, said in a press release. " As more

genetic factors related to Type 2 diabetes are identified and as our

understanding

of the progression of the disease evolves, we can expect to gain precision

in identifying the best drug choices for individual patients and to more

effectively

halt the progression of diabetes. "

An international working group of experts in epidemiology, pathophysiology,

genetics, clinical trials and clinical care participated in an April 2009

conference

during which they reviewed the current knowledge of phenotypic and genotypic

heterogeneity in Type 2 diabetes. The conference was sponsored by The

Endocrine

Society and American Diabetes Association. Then, a writing group prepared

recommendations for individualized treatment of Type 2 diabetes, such as:

Extend analysis of existing data and data sources: data and sources that

could be potentially valuable in individualizing therapy have been largely

underutilized.

Pooled analyses or meta-analyses of such data may provide insight into the

relative effectiveness of specific interventions in subgroups of patients

with

Type 2 diabetes.

Expand existing or develop new data registries: All new and existing

diabetes registries should systematically collect data to address phenotypic

and genetic

heterogeneity measures, including material for future biomarker and genetic

analysis and hypotheses generated by examining existing data.

Develop new clinical trials: future randomized studies of diabetes therapies

should collect phenotypic information relevant to response to therapy.

Develop new technologies: targeting therapy toward more appropriate

subgroups of patients will require increasingly accurate and efficient

methods to measure

markers for diabetes heterogeneity and heterogeneous response to treatment.

Expand basic research: basic research is needed to explore numerous

fundamental issues that underlie the heterogeneous response to diabetes

therapies.

" The recommendations in this consensus statement highlight the need for the

research community and industry to each play their part in improving our

ability

to individualize therapy so that patients can get the most accurate and

appropriate treatment, " A. Vigersky, MD

,

president of The Endocrine Society, said in a press release.

RJ.

J Clin Endocrinol Metab

.. 2010;95:1566-1574.

High Glycemic Foods Can Increase Risk for Heart Disease in Women

Baby Boomers Will Outlive Their Children

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This article originally posted

13 April, 2010

and appeared in

Issue 517

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This article originally posted 13 April, 2010 and appeared in

Issue 517

Using Genotypes to Individualize Diabetes Treatment

A panel of diabetes experts is encouraging efforts to increase understanding

of the heterogeneity of Type 2 diabetes to achieve individualized treatments

and improve treatment responses....

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A new consensus report outlines current knowledge of the heterogeneity of

Type 2 diabetes as well as areas that need to be further explored, based on

phenotypes

and genotypes. Experts also provide recommendations to bring health care

professionals closer to the goal of individualizing therapy.

" Although Type 2 diabetes is considered to be heterogeneous with regard to

its clinical presentation, features and pathogenesis, including

pathophysiology

and underlying genetic risk factors, patients are generally treated

similarly, independent of the underlying differences that might affect

therapeutic

response. Further insight into the heterogeneity of the Type 2 diabetes

patient population might help explain and, ultimately, reduce the high rate

of

treatment failure, " the experts wrote.

Current knowledge is based on head-to-head comparison studies, crude or

deficient baseline phenotyping and genotyping, and inadequate subset

analyses, rendering

the current models of treatment for Type 2 diabetes nonspecific, according

to the report. To date, understanding " has not yet reached a point at which

it can guide individualized therapy decisions, " the experts wrote. However,

progress is apparent.

" Recent advances in genetics, such as the identification of the responsible

genes for several forms of Maturity Onset Diabetes of the Young (MODY), now

referred to as monogenic diabetes, have established precedents linking

specific drug therapies to defined subtypes of diabetes patients, " J.

,

MD, of Brown University, Providence, RI, said in a press release. " As more

genetic factors related to Type 2 diabetes are identified and as our

understanding

of the progression of the disease evolves, we can expect to gain precision

in identifying the best drug choices for individual patients and to more

effectively

halt the progression of diabetes. "

An international working group of experts in epidemiology, pathophysiology,

genetics, clinical trials and clinical care participated in an April 2009

conference

during which they reviewed the current knowledge of phenotypic and genotypic

heterogeneity in Type 2 diabetes. The conference was sponsored by The

Endocrine

Society and American Diabetes Association. Then, a writing group prepared

recommendations for individualized treatment of Type 2 diabetes, such as:

list of 5 items

.. Extend analysis of existing data and data sources: data and sources that

could be potentially valuable in individualizing therapy have been largely

underutilized.

Pooled analyses or meta-analyses of such data may provide insight into the

relative effectiveness of specific interventions in subgroups of patients

with

Type 2 diabetes.

.. Expand existing or develop new data registries: All new and existing

diabetes registries should systematically collect data to address phenotypic

and

genetic heterogeneity measures, including material for future biomarker and

genetic analysis and hypotheses generated by examining existing data.

.. Develop new clinical trials: future randomized studies of diabetes

therapies should collect phenotypic information relevant to response to

therapy.

.. Develop new technologies: targeting therapy toward more appropriate

subgroups of patients will require increasingly accurate and efficient

methods to

measure markers for diabetes heterogeneity and heterogeneous response to

treatment.

.. Expand basic research: basic research is needed to explore numerous

fundamental issues that underlie the heterogeneous response to diabetes

therapies.

list end

" The recommendations in this consensus statement highlight the need for the

research community and industry to each play their part in improving our

ability

to individualize therapy so that patients can get the most accurate and

appropriate treatment, " A. Vigersky, MD, president of The Endocrine

Society,