Millions of people with type 2 diabetes could receive better treatment thanks to a new, simple low-cost tool that can match each individual to the most effective blood glucose-lowering drug for them.
Developed by researchers at the University of Exeter, the tool has the potential to transform type 2 diabetes care worldwide, by helping millions to lower their blood sugar levels and risk of diabetes complications.
The research is being announced at the Diabetes UK Professional Conference 2025 and is published in the Lancet.
Managing blood sugar levels is challenging, and only about a third of people with type 2 diabetes meet target levels.
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 drugs are available. But their effectiveness varies widely from person to person, and it hasn’t been possible to know which treatment will work best for which person – 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, and its accuracy checked with data from clinical trials.
A new era of personalised treatment
The research found that only 18% of people with type 2 diabetes in the UK have been treated with the most effective glucose-lowering drug for them. But using the tool’s treatment recommendations could reduce blood sugar levels (HbA1c) by an average of 5mmol/mol after one year.
Importantly, these improvements in blood sugar 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 complications.
Researchers are now testing the tool’s performance in clinical practice with 22,500 people with type 2 diabetes across Scotland. This will guide its roll-out across the UK and globally, enabling a new era of personalised treatment for people with type 2 diabetes.
Dave Pomfrey, 67, from Hampshire, was diagnosed with type 2 diabetes 27 years ago. He said:
“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.”
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.”
Dr Elizabeth Robertson, Director of Research and Clinical at Diabetes UK, said:
“This innovation using routine clinical data could help countless people with type 2 diabetes to get their blood sugars levels into a safe range, significantly reducing their risk of devastating diabetes complications and easing the burden of living with this relentless condition.
"If shown to be effective in practice and widely adopted by health services in the UK and globally, this tool could mark the most significant advance in type 2 diabetes care in more than a decade, improving health outcomes for millions.”
This research was funded by the Medical Research Council, Wellcome and NIHR Exeter Biomedical Research Centre, and supported by Diabetes UK.
