Evidence map›Paper›PMID 40375735›Full record

ArticleDiabetes, obesity & metabolism2025

Evaluating prediction of short-term tolerability of five type 2 diabetes drug classes using routine clinical features: UK population-based study.

Pedro Cardoso, Katie G Young, Rhian Hopkins, Bilal A Mateen, Ewan R Pearson, Andrew T Hattersley, Trevelyan J McKinley, Beverley M Shields, John M Dennis, MASTERMIND consortium

Abstract read
In one paragraph

Article in Diabetes, obesity & metabolism, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Review
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  3. Article
  4. Observational
  5. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Pedro CardosoClinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK.ORCID 0000-0002-1014-9058
Katie G YoungClinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK.ORCID 0000-0003-2570-3864
Rhian HopkinsClinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK.ORCID 0000-0001-6054-3582
Bilal A MateenInstitute of Health Informatics, University College London, London, UK.ORCID 0000-0003-4423-6472
Ewan R PearsonDivision of Molecular & Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.ORCID 0000-0001-9237-8585
Andrew T HattersleyClinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK.ORCID 0000-0001-5620-473X
Trevelyan J McKinleyClinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK.ORCID 0000-0002-9485-3236
Beverley M ShieldsClinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK.ORCID 0000-0003-3785-327X
John M DennisClinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK.ORCID 0000-0002-7171-732X
MASTERMIND consortium

Funding

Medical Research Council MR/N00633X/1National Institute for Health and Care Research Exeter Biomedical Research CentreNIHR Exeter Clinical Research FacilityWellcome TrustWellcome Trust Early Career award 227 070/Z/23/Z
6 · The paper itself

Abstract

aimsA precision medicine approach in type 2 diabetes (T2D) needs to consider potential treatment risks alongside established benefits for glycaemic and cardiometabolic outcomes. Considering five major T2D drug classes, we aimed to describe variation in short-term discontinuation (a proxy of overall tolerability) by drug and patient routine clinical features and determine whether combining features in a model to predict drug class-specific tolerability has clinical utility. MATERIALS AND

methodsUK routine clinical data (Clinical Practice Research Datalink, 2014-2020) of people with T2D initiating glucagon-like peptide-1 receptor agonists (GLP-1RA), dipeptidyl peptidase-4 inhibitors (DPP4i), sodium-glucose co-transporter-2 inhibitors (SGLT2i), thiazolidinediones (TZD) and sulfonylureas (SU) in primary care were studied. We first described the proportions of short-term (3-month) discontinuation by drug class across subgroups stratified by routine clinical features. We then assessed the performance of combining features to predict discontinuation by drug class using a flexible machine learning algorithm (a Bayesian Additive Regression Tree).

resultsAmongst 182 194 treatment initiations, discontinuation varied modestly by clinical features. Higher discontinuation on SGLT2i and GLP-1RA was seen for older patients and those with longer diabetes duration. For most other features, discontinuation differences were similar by drug class, with higher discontinuation for patients who had previously discontinued metformin, females and people of South-Asian and Black ethnicities. Lower discontinuation was seen for patients currently taking statins and blood pressure medication. The model combining all sociodemographic and clinical features had a low ability to predict discontinuation (AUC = 0.61).

conclusionsA model-based approach to predict drug-specific discontinuation for individual patients with T2D has low clinical utility. Instead of likely tolerability, prescribing decisions in T2D should focus on drug-specific side-effect risks and differences in the glycaemic and cardiometabolic benefits of available medication classes.

Indexed as

Diabetes Mellitus, Type 2Hypoglycemic AgentsAdultAgedDipeptidyl-Peptidase IV InhibitorsFemaleGlucagon-Like Peptide-1 Receptor AgonistsHumansMaleMiddle AgedPrecision MedicineSodium-Glucose Transporter 2 InhibitorsSulfonylurea CompoundsUnited KingdomDipeptidyl-Peptidase IV InhibitorsGlucagon-Like Peptide-1 Receptor AgonistsHypoglycemic AgentsSodium-Glucose Transporter 2 InhibitorsSulfonylurea Compoundsanti‐hyperglycaemic treatmentclinical careDPP4idrug tolerabilityGLP‐1RAprecision medicineSGLT2iSUtreatment effect heterogeneityTZD

Identifiers

PMID40375735
PMCPMC12232322

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.