Together with our collaborator Dr Dorit Samocha-Bonet of the Garvan Institute in Sydney, we are investigating strategies for targeted therapeutic approaches to type 2 diabetes.
The current paradigm is one of trial-and-error, in which metformin therapy is first-line. However, 20–50% of patients do not respond to metformin, after which other agents are tried in a step-wise fashion. In a cohort of patients carefully phenotyped for hepatic or skeletal muscle insulin resistance, we have discovered a new plasma biomarker of hepatic insulin resistance.
While this biomarker is undergoing further validation, it will be developed to guide therapy in the clinic, eg, high levels mean patients would likely benefit from metformin; a low level would suggest patients should bypass metformin. This guided therapeutic approach could avoid unwarranted therapies and unwanted side effects, and ultimately accelerate the path to effective treatment.