If the initial dosage does not work, the clinician must increase the amount gradually until it does. “It's often trial and error,” Florez says. “I'll have to increase the metformin dosage and keep monitoring blood glucose every few weeks.” Often, the change in blood glucose levels is marginal, and it can sometimes take more than a year for Florez to determine that the patient needs an additional second-line therapy or to eliminate metformin altogether. “Currently, there's no way for me to know when a patient comes in if they are going to be responsive to metformin or not,” Florez says. And although between 70% and 80% of individuals with diabetes are responsive to metformin, for those who are unresponsive to the drug, knowing in advance that metformin would not work would spare patients from the side effects associated with the drug.
Now, several large-scale global consortia are bringing together academics and pharmaceutical companies to try to move away from the 'one-size-fits-all' approach to diabetes treatment. These consortia come with several millions of dollars' worth of funding from government agencies and industry partners, and they are collecting genotypic, metabolic, proteomic and phenotypic characteristics—together known as 'omics' data—from millions of patients around the globe to better understand what differentiates one individual's disease from the next. The hope is that this knowledge will also help researchers and clinicians to understand why some people respond to drugs such as metformin, yet others do not—and possibly to design better drugs on the basis of mechanisms and biomarkers that are revealed through mining the omics data.
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