Predicting post one-year durability of glucose-lowering monotherapies in patients with newly-diagnosed type 2 diabetes mellitus – A MASTERMIND precision medicine approach (UKPDS 87)

Olorunsola F. Agbaje (Lead / Corresponding author), Ruth L. Coleman, Andrew T. Hattersley, Angus G. Jones, Ewan R. Pearson, Beverley M. Shields, Rury R. Holman, MASTERMIND consortium

Research output: Contribution to journalArticle

Abstract

Aims: Predicting likely durability of glucose-lowering therapies for people with type 2 diabetes (T2D) could help inform individualised therapeutic choices.

Methods: We used data from UKPDS patients with newly-diagnosed T2D randomised to first-line glucose-lowering monotherapy with chlorpropamide–glibenclamide–basal insulin or metformin. In 2339 participants who achieved one-year HbA 1c values <7.5% (<59 mmol/mol)–we assessed relationships between one-year characteristics and time to monotherapy-failure (HbA 1c ≥ 7.5% or requiring second-line therapy). Model validation was performed using bootstrap sampling.

Results: Follow-up was median (IQR) 11.0 (8.0–14.0) years. Monotherapy-failure occurred in 72%–82%–75% and 79% for those randomised to chlorpropamide–glibenclamide–basal insulin or metformin respectively–after median 4.5 (3.0–6.6)–3.7 (2.6–5.6)–4.2 (2.7–6.5) and 3.8 (2.6– 5.2) years. Time-to-monotherapy-failure was predicted primarily by HbA 1c and BMI values–with other risk factors varying by type of monotherapy–with predictions to within ±2.5 years for 55%–60%–56% and 57% of the chlorpropamide–glibenclamide–basal insulin and metformin monotherapy cohorts respectively.

Conclusions: Post one-year glycaemic durability can be predicted robustly in individuals with newly-diagnosed T2D who achieve HbA 1c values < 7.5% one year after commencing traditional monotherapies. Such information could be used to help guide glycaemic management for individual patients.

Original languageEnglish
Article number108333
Number of pages8
JournalDiabetes Research and Clinical Practice
Volume166
Early online date21 Jul 2020
DOIs
Publication statusPublished - Aug 2020

Keywords

  • Precision medicine
  • modelling
  • durability
  • glucose-lowering agents
  • monotherapy failure
  • Monotherapy failure
  • Durability
  • Modelling
  • Glucose-lowering agents

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