November is diabetes awareness month in the U.S., a time to learn more about a disease that affects an estimated 30 million American children and adults.
According to data from the Centers for Disease Control and Prevention (CDC), the number of adults with diabetes nearly tripled between 1980 and 2011, going from 5.6 million people to 20.9 million. The American Diabetes Association estimates the total national cost of diagnosed diabetes at $245 billion.
Proper nutrition, physical activity and control of blood sugar levels are the cornerstones of treatment and prevention of diabetes, says the National Diabetes Education Program, with diabetes medications also being a key player in these strategies. The CDC reports that between 1997 and 2011, the percentage of people with diabetes taking both insulin treatment and pills increased from 9.1 percent to 13 percent.
Researchers are recognizing the role of an individual’s genetics in response to many common medications used to treat diabetes. Variants of the gene CYP2C9, which codes for drug-metabolizing enzymes in the liver, have the potential to alter blood levels of certain diabetes drugs, possibly necessitating a change in dosage.
For example, a 2013 review study in the scientific journal Biochema Medica reviewed studies that found that those who had CYP2C9 variations were not able to clear the diabetes drug glyburide as effectively as those with normal CYP2C9 activity. This could lead to buildup of the medication in the blood stream and increased risk of low blood sugar. This risk would be even more dangerous in those with “hypoglycemia unawareness,” or having low blood sugar without feeling symptoms.
Though the authors cite “significant evidence” to demonstrate an association between specific gene variants and differing responses to diabetes medications, they call for more clinical trials to further assess the utility of pharmacogenomics for individualized treatment. Pharmacogenomics generally refers to the study of genetic variations that influence individual response to drugs.
“With recent scientific and technological advances, pharmacogenomics has a great potential to yield therapeutic advances leading the way towards personalized diabetes care,” the review study authors write.
A 2012 position statement from the American Diabetes Association and the European Association for the Management of Diabetes on the management of hyperglycemia also recognized the potential of pharmacogenetics to improve diabetes treatment decisions, and the need for more clinical trials in this area.
“Pharmacogenetics may very well inform treatment decisions in the future, guiding the clinician to recommend a therapy for an individual patient based on predictors of response and susceptibility to adverse effects,” the position statement authors write.