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population exposed to prolonged periods of damaging hyper-
glycaemia. There is now a consensus that further insight into the differences
34
between people with T2DM, both physiologic and genetic, should not
only help elucidate the pathogenesis of this disease, but lead to indi-
vidualised treatments for patients that will improve glycaemic control,
maximise individual benefit, minimise risk, reduce diabetes complica-
tions, and ultimately provide reductions in global health cost. The re-
34
cent consensus published in the Journal of Clinical Endocrinology and
Metabolism (Smith et al., 2010) makes a series of recommendations for
increasing understanding of the heterogeneity of T2DM and achieving
the goal of individualising therapy and improving treatment response
(Table 1). 34

Table 1. Recommendations for individualising therapies in T2DM based on patient charac-
teristics. 34

Recommendation Specific details
Extend analysis of existing • There are already a plethora of data and data sources
data and data sources that could be potentially valuable in individualising
therapy; however, to date, these have been largely under-
utilised.
• Pooled analyses or meta-analyses of such data may
provide important insights into the relative effectiveness of
specific interventions in subgroups of patients with T2DM
and advance our understanding of individualised therapy.
Expand existing or develop • All new and existing diabetes registries should systemati-
new data registries cally collect data to address phenotypic and genetic het-
erogeneity measures.
• Not only should these registries collect material for future
biomarker and genetic analysis, but registries should
be designed to specifically address the heterogeneity of
diabetes with hypotheses generated by examining exist-
ing data.
Develop new clinical trials • Future randomised studies of diabetes therapies should,
by design, collect phenotypic information relevant to re-
sponse to therapy.
Develop new technologies • Targeting therapy toward more appropriate subgroups of
patients will require increasingly accurate and efficient
methods to measure markers for diabetes heterogeneity
and heterogeneous response to treatment.
Expand basic research • Basic research is needed to explore numerous fundamen-
tal issues that underlie the heterogeneous response to
diabetes therapies.

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