Cutting-edge ‘precision medicine’ has huge potential to advance the diagnosis, treatment and ultimate prevention of various forms of diabetes, says an international coalition of scientists in a thorough review of the current state of the field around the world. The results of the evaluation were reported.
A comprehensive new international report looks at the potential of ‘precision medicine’ to improve diabetes care.Image credit: UVA Health
The new international ‘consensus report’ reviewed published scientific literature and was compiled by more than 200 experts from 28 countries. We focus on areas where precision medicine is already transforming diabetes diagnosis, prevention, treatment, and monitoring. But it also serves as a roadmap for the future, identifying areas where research is critically needed and recommending actions that can be taken immediately to improve patient care.
“This international consortium study, which took more than three years and was done entirely through the efforts of volunteers, will help us understand where precision diabetes medicine works and, more importantly,” said Stephen S., from the University of Virginia School of Medicine. , to determine what the knowledge gaps and barriers to implementation are.” Dr. Rich is co-chair of the Diabetes Precision Medicine Initiative (PMDI), which produced this report. “Diabetes is a heterogeneous disease, and the classic definition of type 2 diabetes, for example, is too simplistic, making diagnosis (Is it really type 2 diabetes?) and treatment (what are the best drugs to achieve normal blood sugar levels? (or are behavioral changes such as increased exercise and improved diet sufficient?) and prognosis (such as heart disease, kidney disease, etc., which require more intensive follow-up and monitoring). , or other complications of diabetes?). Crucially, the heterogeneity of diabetes applies across the globe, rather than just in resource-rich countries or populations. We need to develop an understanding of
About diabetes precision medicine
Personalized medicine is tailored to the individual, rather than providing the same treatment to everyone, as has been the case in the past. This approach is primarily known for cancer research, where individualized treatment decisions are made for each individual. In contrast, precision medicine is based on identifying groups of people with similar disease characteristics, similar responses to treatment, and risk of complications. Precision diabetes medicine incorporates information about an individual’s genes, lifestyle, and other factors to ensure each person receives the care that is best for them. The outcome of precision medicine is increasing the ability of personalized medicine to deliver the right effects and improved outcomes for each person.
To assess the current state and potential of diabetes precision medicine, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened the Diabetes Precision Medicine Initiative in 2018. The initiative’s new consensus report – second edition – represents significant progress in implementing the approach. For example, precision medicine is helping to reduce the risk of many forms of monogenic diabetes (a type of diabetes caused by a single gene mutation, which accounts for 2% to 3% of all diabetes cases), thanks to significant advances in genetic testing. It plays an important role in diagnosis and treatment. .
“Precision medicine holds great promise in the field of monogenic diabetes, as highly accurate diagnoses can be achieved using genomics to guide treatment selection,” said the report’s chair. said Dr. Paul Franks, Dean of Medical Sciences. Novo He received his PhD in Translational Medicine from the Nordisk Foundation.
Although all types of diabetes have a genetic basis, only monogenic forms of diabetes have a known single mutation that can provide a specific diagnosis and optimal treatment plan. Other forms of diabetes have many genetic variations and non-genetic factors that contribute to risk.
Short-term application in precision medicine
Precision medicine also shows promise in the management of gestational diabetes, a type of diabetes that can develop in mothers during pregnancy and increases the risk of type 2 diabetes for both mother and child, the report said. ing. Certain maternal characteristics, such as age, body mass index (BMI), and family history of diabetes, have been identified as predictors of treatment success or failure.
From the perspective of type 1 diabetes prevention, this report identifies genetic risk classification as one of the most promising areas for immediate clinical implementation. A recent study by Rich and his UVA researchers identified his 90% genetic risk for type 1 diabetes. With this information, doctors can examine your child’s genetic risks to determine whether they have an increased chance of developing type 1 diabetes. For those most at risk, doctors can screen for the presence of islet autoantibodies, which indicate the immune system is attacking the body’s insulin-producing beta cells. This may allow the introduction of important immune interventions.
For type 2 diabetes, the consensus report provides evidence that routine clinical features can help predict how effective different types of drugs will be in treating the condition. The report also suggests how this common form of diabetes (almost 90% of all diabetes) can be classified into more precise subtypes.
While the consensus report focuses on areas where precision medicine can improve clinical practice, it also draws attention to research gaps and the need for improved research methods.
A series of knowledge gaps have been identified by experts across all forms of diabetes. It has become clear that published findings are primarily for people of white European ancestry in resource-rich countries and often do not provide strong statistical support for their findings. I did. As a result, the use of multiple data sources, the development of scalable and inexpensive assays for biomarkers, the understanding of both clinical and social/behavioral factors, and the consideration of diabetes across the lifespan, including the use of multiple data sources to target diverse populations. Further research is required. ”
Rich, Center for Public Health Genomics and UVA School of Public Health Sciences
Survey results announced
Franks presented the consensus report’s key findings at the EASD Annual Meeting in Hamburg, Germany, this month. This report is natural medicine Held simultaneously with the EASD Symposium. At the same time, a systematic evidence review summarized in a consensus report communication medicinea series of parallel papers on precision medicine Lancet Diabetes and Endocrinology.
This project was supported by the American Diabetes Association, the European Diabetes Association, and the Novo Nordisk Foundation.