Diabetes: Is There a Future for Pharmacogenomics Guided Treatment?

We have shown this to be the case for metformin response, where the heritability is spread evenly across all the chromosomes, rather than being driven by a few loci of large effect.2

Ewan R. Pearson

2019

Scholarcy highlights

  • Diabetes is a disease defined on the basis of hyperglycemia
  • Most diabetes drugs act to attempt to reverse the pathophysiological defects that contribute to the development of diabetes and differences in etiology are likely to impact on response to drugs that primarily work on this pathway
  • Some drugs lower blood glucose via a distinct mechanism that is not etiological for diabetes, and in this scenario, genetic variation in etiology is unlikely to map to variation in drug response
  • In current clinical practice, genetic etiology of diabetes has been shown to have a big impact on treatment response in the small group of patients who have monogenic diabetes, and for these patients finding the genetic etiology can be life-­changing— transitioning successfully off insulin onto sulfonylurea treatment
  • Whilst a number of robust genetic variants have been established to be associated with glycemic response to metformin, Figure 4 The future role of pharmacogenetics in type 2 diabetes—a summary of the robust and clinically relevant drug–gene interactions that will be of likely clinical utility but only when a preemptive genotyping approach is adopted
  • To answer the question posed in the title of the review, I am in no doubt that pharmacogenetics will become mainstream in the management of diabetes— monogenic diabetes and in type 2 diabetes

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