#1. I am currently studying genetic influences that impact anti-diabetic (Type 2 diabetes) drug response to a specific medication (e.g. metformin). But we know that Type 2 Diabetes is a disease that is significantly influenced by a patient’s environment. Based on randomized control studies comparing standard drug treatment to diet/exercise intervention, we know that non-pharmacological intervention can be equivalent or superior to drug intervention in controlling Type 2 Diabetes or reaching an initial diagnosis of Type 2 diabetes. Thus factors that influence a patient’s environment such as income, education and material are important determinants in drugs response to anti-diabetes medication. Income not only influences a patient’s ability to be evaluated for Type 2 Diabetes but also to purchase the prescribed medication, particularly if that patient does not have insurance or if the medication is a newly FDA-approved medication that is brand. Education level affects the ability of the patient to comprehend the severity of their disease and to properly administer drug treatment. Patient’s who cannot read or read at a rudimentary level will have difficulty understanding and following directions on the drug prescription thus increasing their risk of drug under or overdosing. Also patients who struggle to understand the “long term effects” and the chronic nature of Type 2 Diabetes may decide not to take their medications on a regular basis. Material influences the resources that a patient has in their social circles and overall community. If a patient lives in an isolated community (e.g. rural) or in a community where they do not live in close proximity to a pharmacy, there will be more barriers to obtaining their medication prescription in a timely and consistent manner.
#2. Patients who grow up in a low-income family that resides in a neighborhood that is a food desert have a higher risk of juvenile obesity and juvenile Type 2 Diabetes. As they grow, the children’s disease could progress to severe form of Type 2 Diabetes overtime (higher HbA1c levels). Per American Diabetes Association Diabetes care guidelines 2016, patients who have significantly high blood glucose levels (e.g. HbA1c greater than 10) should be started with multi-drug regimen rather than metformin monotherapy because patients with more severe Type 2 Diabetes will often require more than one medication in order to get their blood glucose levels in an acceptable therapeutic range. Patients who grew up in a neighborhood designated a food desert may not have learned how to cook with or have access to healthy foods that can help mitigate abnormal blood glucose levels (low glycemic vegetables, high fiber carbohydrates, etc) also putting them at risk for uncontrolled Type 2 Diabetes. And the more severe or uncontrollable their disease is, the more unlikely it will be that the patient will respond well to just one anti-diabetes drug treatment.