Groundbreaking new tool accurately predicts the most effective type 2 diabetes drug for an individual, offering major reductions in blood glucose levels and risk of diabetes complications
Millions of people with type 2 diabetes could receive better treatment thanks to a new, simple low-cost tool, according to research announced at the Diabetes UK Professional Conference 2025 and published in the Lancet.
Researchers at the University of Exeter, funded by the Medical Research Council, Wellcome, and supported by NIHR Exeter Biomedical Research Centre and Diabetes UK, have developed an innovative way of identifying the most effective glucose-lowering drugs for a person with type 2 diabetes. By predicting which drug will lead to the largest reduction in blood glucose levels, the easy-to-use tool could pave the way for better health for millions, at the push of a button.
Careful management of blood glucose levels is essential for reducing the risk of serious diabetes complications. However, keeping blood glucose levels in a safe range can be challenging, with only about a third of people with type 2 diabetes meeting targets. With diabetes-related complications devastating lives and costing the UK healthcare system £6.2 billion every year, there is an urgent need for new approaches to improve blood glucose management.
In England alone, more than three million people with type 2 diabetes use glucose-lowering drugs to manage their condition. While metformin is the most common first treatment, five other major types of glucose-lowering drugs are available. However, their effectiveness varies widely from person to person and it has not been possible to determine the best glucose-lowering treatment for each patient – until now.
The new tool was created to tackle the challenge of which drug to choose after metformin. It was developed and tested using data from one million people with type 2 diabetes in the UK, linking GP and hospital records, with its accuracy verified with data from clinical trials.
The research revealed that only 18% of people with type 2 diabetes in the UK have been treated with the most effective glucose-lowering drug for them.
Modelling showed that starting people on the drug recommended by the new tool could lead to marked reductions in blood glucose levels (HbA1c) at one year, of around 5mmol/mol on average. Importantly, these improvements in blood glucose levels could approximately double the time until people need to start taking further diabetes medications. The tool’s use was also predicted to lower risks of developing serious long-term diabetes complications including heart attacks, strokes and kidney disease.
Using routinely collected clinical information, the tool offers a low-cost, practical, immediately usable solution that could transform the treatment of type 2 diabetes. For millions of people with type 2 diabetes, its use would ensure they receive the best treatment to help keep their blood sugars in target range and minimise their risk of developing life-limiting complications.
Dave Pomfrey, 67, from Hampshire, was diagnosed with type 2 diabetes 27 years ago. Dave was told he would need medication to manage his blood glucose levels and help reduce the risk of complications.
“The prospect of taking medication, potentially for life, along with the threat of complications was worrying. But having seen the impact of health complications faced by my relatives, who also had type 2 diabetes, I was willing to try anything.
“Over the years, I have experienced many changes to my medication to keep my blood glucose levels within range. Getting the most appropriate treatment as early as possible and reducing the back and forth of trying different medications could have such an impact on a person’s wellbeing.”
The tool’s performance in clinical practice is currently being assessed in 22,500 patients with type 2 diabetes across Scotland, which will inform its roll-out across the UK and globally, enabling a new era of personalised treatment for people with type 2 diabetes.
Dr 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, that could benefit everyone with type 2 diabetes in the UK and worldwide. 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.”
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. We hope that we can roll out the model quickly to make it available to help people with type 2 diabetes in the UK and across the world.”
The research paper is entitled, A five-drug class model using routinely available clinical features to optimise prescribing in type 2 diabetes: a prediction model development and validation study, and is published in The Lancet. The tool can be viewed at https://www.diabetesgenes.org/t2-treatment/.
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