Individualized Treatment of Type 2 Diabetes Mellitus Using Noninsulin Agents: Clinical Considerations for the Primary Care Physician

Abstract

Background: The outcomes associated with some therapies may be potentially influenced by specific patient characteristics. Individualized therapy is an effort to achieve optimal health outcomes for a patient by selecting drugs known to be beneficial in persons with specific attributes or disease characteristics. With a broad literature base spanning several different medication classes, there is increasing potential for individualization of therapy in the treatment of type 2 diabetes mellitus. Purpose: To review the literature for data that support associations between patient characteristics and outcomes resulting from treatment with antihyperglycemic medications. Results and Conclusions: Review of the medical literature suggests that 3 general considerations are important for individualized therapy: disease pathophysiology, modifiers of treatment response, and risks of nonadherence. Currently, there are limited data demonstrating that nongenetic patient characteristics modify treatment response, while a number of genetic polymorphisms are known to influence the pharmacology of certain antidiabetic agents. The available literature includes evaluation of key nongenetic factors, such as age, race, body mass index, patient sex, disease duration, and baseline glycated hemoglobin level. Of these, glycated hemoglobin level is the best–described laboratory value correlated with treatment response. Recent literature has brought to physicians' attention the more practical aspects of treatment that can influence outcomes, mainly those associated with medication adherence. These include out–of–pocket costs, tolerability/side effects, and the complexity of daily treatment regimens.

Keywords:

• type 2 diabetes mellitus
• individualized treatment
• noninsulin agents