The Role of Pharmacogenomics in Diabetes, HIV Infection, and Pain Management

Diabetes mellitus has emerged as a major public health epidemic in the 21st century. Type 2 diabetes is the most prevalent form of diabetes in adults, accounting for 90 to 95% of cases worldwide. A large pharmacologic treatment armamentarium exists for type 2 diabetes, but it is difficult to predict which patients will derive the best efficacy or be predisposed to toxicity for a given antidiabetic medication. As such, the potential of pharmacogenomics to aid in the selection of antidiabetic drug therapy has garnered considerable attention in the last decade. This chapter will review major antidiabetic drug classes (sulfonylureas, biguanides, and thiazolidinediones) for which there exists a moderate amount of pharmacogenomic research. Within this framework, the most clinically relevant findings from candidate gene studies and/or genome-wide association studies will be highlighted for each drug class. In addition, this chapter will discuss the challenges and opportunities associated with the potential translation of pharmacogenomic information to the clinical management of diabetes. Finally, an overview of how genetic variation also plays a role in drug development for management of patients with HIV-1 infection and in interindividual responses to pain therapy is presented. © 2013