A tool designed to predict which drug will most effectively lower blood sugar levels could enhance treatment for people with type 2 diabetes, if validated for clinical practice.
The initiative was announced this week at the Diabetes UK Professional Conference 2025 and published in The Lancet.
Developed by researchers at the University of Exeter, currently for academic purposes only, the tool enables clinicians to identify the most effective glucose-lowering medication for each patient.
In England, over three million people rely on one of the six major types of glucose-lowering medication, with metformin being the most commonly used.
However, the efficacy of the medication can vary significantly between patients, and there has not been a reliable way to predict which drugs would work best for each patient.
Which medication?
Researchers created the tool to address the challenge of selecting the best medication to use after metformin and predict how well five different classes of diabetes medications lower blood sugar levels, measured by HbA1c levels over 12 months.
To predict how well each of the drugs would work for an individual patient, the researchers used nine common clinical factors, all of which are routinely recorded in medical records. The data included age, sex, and current health measurements such as blood sugar levels, BMI, kidney function, cholesterol levels and liver function tests.
To develop and validate the model, researchers analysed GP and hospital records from over one million people in the UK collected between 2004 and 2020 and validated their findings with data from clinical trials.
Personalised approach
The study highlighted that only 18 per cent of people with type 2 diabetes in the UK have received the most effective glucose-lowering medication for their condition.
Its findings suggested that using the new tool could significantly reduce HbA1c levels by an average of 5 mmol/mol over one year. Patients who followed the model’s suggested treatment had lower HbA1c after 12 months and were less likely to need additional diabetes medications over time. Additionally, they faced a reduced risk of diabetes-related complications compared to those on non-optimal treatments.
John Dennis, Associate Professor at the University of Exeter who led the study, said: ‘We have developed a completely new personalised approach for diabetes treatment. For the first time, our model allows people living with type 2 diabetes to quickly identify the best treatment to manage their blood sugar levels, helping reduce their risk of diabetes complications. This offers a major advance on the current approach to choosing diabetes medications.’
The tool is currently being tested in clinical practice in 22,500 patients with type 2 diabetes across Scotland, which will inform its roll-out across the UK and globally.
Professor Andrew Hattersley from the University of Exeter added: ‘Critically, our model can be implemented in clinical care immediately and at no additional cost. This is because it uses simple measures such as sex, weight and standard blood tests that are performed routinely.’
